PURPOSE Intra-abdominal infection is a common postoperative complication of laparoscopic pylorus-preserving gastrectomies (PPGs). Many studies have reported that intra-abdominal infectious complications after gastrectomy adversely affect patient survival outcomes. To prevent gastric fluid leakage into the abdominal cavity, we developed a novel anastomosis method in which the stomach lumen is not opened (termed the non-opened clean end-to-end anastomosis method [NoCEAM]) and evaluated its feasibility. MATERIALS AND METHODS Subsequent to lymphadenectomy, the oral and anal resection lines were sutured using an intraoperative endoscope. After closing the stomach circumferentially with clips, the specimen was rolled outward like a "donut." We resected the specimen circumferentially using a linear stapler, and anastomosis was completed simultaneously. We examined the feasibility of this procedure ex vivo, using three porcine stomachs, and in vivo, using one pig. Subsequently, we applied the procedure to 13 consecutive patients with middle-third early gastric cancer utilizing laparotomic, laparoscopic, and robotic PPG. RESULTS NoCEAM was completed in all porcine models and human cases. In the human cases, the mean operation time (±standard deviation) was 279±51 minutes, and mean blood loss volume was 22±45 mL. The mean number of linear staples used was 5.06±0.76. None of the patients had complications, and all were discharged on the eighth postoperative. The serum total protein, serum albumin, and hemoglobin levels did not change significantly after surgery. CONCLUSIONS NoCEAM is feasible and safe for performing totally laparoscopic or robotic PPG. It may reduce postoperative complications, such as intra-abdominal infections.

中文翻译：

---

在完全腹腔镜或机器人保留幽门胃切除术中，无需打开胃腔的新型清洁端对端吻合方法。

目的腹腔内感染是腹腔镜保留幽门胃切除术（PPG）的常见术后并发症。许多研究报告称，胃切除术后腹内感染并发症会对患者的生存结果产生不利影响。为了防止胃液漏入腹腔，我们开发了一种不打开胃腔的新型吻合方法（称为非开放清洁端端吻合法[NoCEAM]）并评估其可行性。材料和方法 淋巴结切除术后，使用术中内窥镜缝合口腔和肛门切除线。用夹子沿圆周封闭胃后，将样本像“甜甜圈”一样向外卷起。采用直线吻合器沿周向切除标本，同时完成吻合。我们使用三个猪胃在体外检查了该程序的可行性，并使用一只猪在体内检查了该程序的可行性。随后，我们利用腹腔镜、腹腔镜和机器人 PPG 将该手术应用于连续 13 名中三分之一早期胃癌患者。结果 NoCEAM 在所有猪模型和人类病例中均已完成。在人类病例中，平均手术时间（±标准差）为279±51分钟，平均失血量为22±45 mL。使用的线性订书钉的平均数量为 5.06±0.76。所有患者均未出现并发症，均于术后第8天出院。术后血清总蛋白、血清白蛋白、血红蛋白水平无明显变化。结论 NoCEAM 对于进行完全腹腔镜或机器人 PPG 是可行且安全的。它可以减少术后并发症，例如腹内感染。