Benefits of xiphoidectomy in total gastrectomy: Technical note
Mehmet Mihmanlı, Hakan Mustafa Köksal, Uygar Demir, Rıza Gürhan Işıl
Clinic of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
Objective: The esophago-gastric junction may be challenging during total gastrectomy due to gastric cancer. This situation may compromise the security of both the dissection and anastomosis. The purpose of this study was to investigate the usefulness of xiphoidectomy to overcome this issue.
Material and Methods: The files of patients who underwent total gastrectomy + D2 lymph node dissection due to proximal gastric cancer or cardia cancer between April 2002-December 2013 were retrospectively evaluated. We assessed the outcome in patients with xiphoidectomy in addition to the midline incision in terms of xiphoidectomy technique, xiphoidectomy time, and operative and postoperative complications.
Results: Thirty cases were identified to undergo xiphoidectomy. Nineteen patients were male and 11 were female, with a mean age of 51 (21-80) years. The time required for xiphoidectomy was 7-15 minutes (mean 8.7 minutes). The mean additional time required for the closure of the incision in cases with xiphoidectomy was 2 minutes. There was minimal arterial bleeding from the diaphragmatic surface in one patient, which was controlled by electrocautery. Only two patients developed wound infection.
Conclusion: Performing xiphoidectomy is quite easy, after a certain learning phase. The operative time was 7-15 minutes longer due to excision of xiphoid and closure of the related defect. Minor hemorrhage was a problem during surgery. There were no early or late post-operative complications. We suggest that the procedure is beneficial in selected cases with requirement of a wider operative field or better exposure of the esophago-gastric junction during total gastrectomy for gastric cancer, and recommend removal of the xiphoid bone.
Keywords: Xiphoidectomy, xiphoid process, total gastrectomy, esophago-gastric junction
Because this study is a retrospective study, ethics committee approval was not provided.
Informed consent form including the treatment protocol and possible surgical techniques and options was taken from all patients included in this study.
Concept - M.M.; Design - M.M., H.M.K.; Supervision - M.M., H.M.K.; Funding - H.M.K.; Materials - U.D.; Data Collection and/or Processing - H.M.K., R.G.I.; Analysis and/or Interpretation - M.M., H.M.K., U.D., R.G.I.; Literature Review - H.M.K., U.D., R.G.I.; Writer - H.M.K.; Critical Review - R.G.I; Other - H.M.K., U.D., R.G.I.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.