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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(02): E224-E225
DOI: 10.1055/a-1723-3516
Letter to the editor

Timing of Kocher maneuver in laparoscopic endoscopic cooperative surgery for duodenum tumor: Before or after endoscopic submucosal dissection?

Ken Hagiwara
1   Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
,
Ryoji Ichijima
2   Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
,
Takuji Gotoda
2   Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
,
Hiroharu Yamashita
1   Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
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We read with great interest the recent article by Otowa and colleagues [1]. They retrospectively evaluated the short-term outcomes of 10 patients with superficial non-ampullary duodenal epithelial tumors (SNADET) treated by laparoscopic endoscopic cooperative surgery for duodenum tumor (D-LECS) and reported their techniques in detail. Based on the high rate of intraoperative perforation in their study (40 %), ensuring confirmation and reinforcement of the thin duodenal wall appears to be mandatory after endoscopic submucosal dissection (ESD). Given that duodenal ESD alone is associated with a high rate of complications, such as delayed perforation [2], we totally agree with them that laparoscopic seromuscular suture would effectively prevent such an event.

D-LECS consists mainly of ESD and laparoscopic reinforcement. The former is essential for this procedure. Because loss of duodenal fixation on the retroperitoneum caused difficulty with ESD, Otowa and colleagues clearly advocated the Kocher maneuver, mobilization of the duodenum and head of the pancreas from the retroperitoneum, not being completed before ESD. However, whether this procedure is optimally performed before versus after ESD depends on duodenal tumor location.



Publication History

Article published online:
16 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Letter to this article:

Safe management of laparoscopic endoscopic cooperative surgery for superficial non-ampullary duodenal epithelial tumorsEndosc Int Open 2017; 05(11): E1153-E1158
DOI: 10.1055/s-0043-117957

Letter to this article:

Reply to: Timing of Kocher maneuver in laparoscopic endoscopic cooperative surgery: Before or after endoscopic submucosal dissection?Endosc Int Open 2022; 10(02): E226-E226
DOI: 10.1055/a-1722-7982

 

  • References

  • 1 Otowa Y, Kanaji S, Morita Y. et al. Safe management of laparoscopic endoscopic cooperative surgery for superficial non-ampullary duodenal epithelial tumors. Endosc Int Open 2017; 5: E1153-E1158
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Marques J, Baldaque-Silva F, Pereira P. et al. Endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of sporadic nonampullary duodenal adenomatous polyps. World J Gastrointest Endosc 2015; 7: 720-727
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