Postoperative Complication and Its Control Following Total Gastrectomy for Gastric Cancer

Kiyoshi Sawai

First Department of Surgery, Kyoto Prefectural University of Medicine

The secret of safe total gastrectomy with acceptable postoperative complications includes an appropriate approach and use of a retractor to provide a good operative field, keeping to the fundamentals in reconstruction, and effective drainage. The first choice for esophagogastrostomy is auto suture. Howerver, when problems occurred during auto suturing, repair should be done by hand suturing. Re-laparotomy is effective against primary postoperative bleeding and arterial embolization is effective against secondary postoperative bleeding. Anastomotic leakage can be cured by effective drainage, after its exact determination of its location, quantity and effectiveness of drainage by fluoroscopy. Massive bleeding due to pancreatic fistula can be controlled by arterial embolization. Conservative therapy using a long balloon catheter for intestinal obstruction due to adhesions should be continued for 7 to 10 days. When conservative treatment is ineffective against postoperative cholecystitis, percutaneous trnashepatic gall bladder drainage should be used. An abscess in the peritoneal cavity can be diagnosed by echography or computed tomography and drainage should be done under the guidance of echography or computed tomography.

Key words
gastric cancer, postoperative complication, total gastrectomy

Reprint requests
Kiyoshi Sawai First Department of Surgery, Kyoto Prefectural University of Medicine
Kawaramachi, Hirokoji, Kamigyo-ku, Kyoto, 602 JAPAN

Accepted
November 16, 1995

To read the PDF file you will need Abobe Reader installed on your computer.