Intracorporeal esophagojejunostomy using the double stapling technique after laparoscopic total gastrectomy: A retrospective case-series study

Abstract

AIM:To introduce a simple and safe anvil insertion technique to esophagus during laparoscopic total gastrectomy (LTG). METHODS:Between July 2010 and December 2012, 58 consecutive patients with early gastric cancer underwent LTG were enrolled. We performed a simple and safe Roux-en-Y esophagojejunostomy using the double stapling technique to all patients. Then patients' characteristics, perioperative outcome and histopathologic data were analyzed retrospectively. RESULTS:The mean age and body mass index were 59.3 ± 9.7 years and 22.7 ± 2.6 kg/m 2 . The mean operation, reconstruction and anvil insertion times (from gastric incision to linear stapling) were 251.8 ± 57.0, 43.1 ± 2.8 and 4.2 ± 1.9 min, respectively. Intraoperative blood loss was 204.6 ± 156.3 mL and there was no open conversion. The postoperative complications were in 8 cases (delayed gastric emptying in 4 cases, pulmonary complication in 2 cases, pancreatitis in 1 case, anastomotic stricture in 1 case). Anastomotic stricture occurred after discharge and was recovered by endoscopic intervention. The patients were discharged at a mean of 9.6 ± 2.0 d after surgery. Neither leakage nor bleeding from the esophagojejunostomy occurred postoperatively. The mean proximal margin of specimen was 2.7 ± 2.8 cm CONCLUSION: Roux-en Y esophagojejunostomy using

Comparison of Intracorporeal and Extracorporeal Esophagojejunostomy after Laparoscopic Total Gastrectomy for Gastric Cancer

“…[ 35 36 ] We also collected several studies reported IEJ techniques in large scales and summarized them in Table 4 . [ 37 38 39 40 41 42 43 44 45 ] The surgical outcomes including operation time, blood loss, bowel recovery, and LOH were in accordance with the study.…”

Survey on laparoscopic total gastrectomy at the 11th China‐Korea‐Japan Laparoscopic Gastrectomy Joint Seminar

“…The type of stapler used for E‐J stomy has always been a controversial topic. Linear staplers and circular staplers perform comparably during LTG . Supporters of each stapler have their arguments and evidence, but there is no agreement according to our survey.…”

“…It is hard to explain why Chinese surgeons prefer a 60‐mm stapler, whereas Korean and Japanese surgeons use a 45‐mm stapler. With regard to a purse‐string suture with a 25‐mm circular stapler, both hand‐sewn and device‐assisted sutures have already been introduced, but their performance has rarely been compared in a prospective way .…”

Systematic review and meta-analysis of perioperative compilations of hand-sewn esophagojejunostomy used for laparoscopic total gastrectomy

“…Furthermore, the use of circular staplers presents additional challenges, including technical difficulties associated with the positioning of the stapler anvil. While systems of transoral anvil delivery have been developed, which can damage esophageal mucosa and can cause bacterial infections of the abdominal cavity [21].…”