Safety of intracorporeal circular stapling esophagojejunostomy using trans-orally inserted anvil (OrVil™) following laparoscopic total or proximal gastrectomy - comparison with extracorporeal anastomosis

Choi

et al. 2015

WJG

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

Section: Discussionmentioning

confidence: 99%

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

Choi

et al. 2015

WJG

Annals of Gastroent Surgery

“…Some other reports have demonstrated good short-term results after EJS with circular stapler (CS) carried out through a small incision. [46][47][48] However, inserting and fixing the anvil head into the esophageal stump is sometimes difficult in a narrow and deep operative field. Safe and secure anastomosis is difficult to carry out, requiring careful attention to avoid intervening in surrounding tissues between the anastomotic plane, especially in obese patients.…”

Section: Reconstructionsmentioning

confidence: 99%

“…We reviewed anastomotic complications, especially those reported on leakage and stricture, in 43 extracted studies of LTG. 33,46,48,[52][53][54][55][56] We compared the surgical results of various anastomotic procedures for EJS using the CS, with attention to the insertion procedure of the anvil and the insertion site of the anastomotic device.…”

Section: Circular Staplermentioning

confidence: 99%

Current status of laparoscopic total gastrectomy

Kawaguchi

Shiraishi

Akaike

et al. 2018

In this article, the current state of laparoscopic total gastrectomy (LTG) was reviewed, focusing on lymph node dissection and reconstruction. Lymph node dissection in LTG is technically similar to that in laparoscopic distal gastrectomy for early gastric cancer; however, LTG for advanced gastric cancer requires extended lymph node dissections including splenic hilar lymph nodes. Although a recent randomized controlled trial clearly indicated no survival benefit in prophylactic splenectomy for lymph node dissection at the splenic hilum, some patients may receive prognostic benefit from adequate splenic hilar lymph node dissection. Considering reconstruction, there are two major esophagojejunostomy (EJS) techniques, using a circular stapler (CS) or using a linear stapler (LS). A few studies have shown that the LS method has fewer complications; however, almost all studies have reported that morbidity (such as anastomotic leakage and stricture) is not significantly different for the two methods. As for CS, we grouped various studies addressing complications in LTG into categories according to the insertion procedure of the anvil and the insertion site in the abdominal wall for the CS. We compared the rate of complications, particularly for leakage and stricture. The rate of anastomotic leakage and stricture was the lowest when inserting the CS from the upper left abdomen and was significantly the highest when inserting the CS from the midline umbilical. Scrupulous attention to EJS techniques is required by surgeons with a clear understanding of the advantages and disadvantages of each anastomotic device and approach.

Asian J Endoscop Surgery

“…Despite this, potential postoperative complications, such as anastomotic leakage and stricture, can occur after esophagojejunostomy performed with an OrVil. The reported incidence of anastomotic leakage ranges from 0% to 16%, and the incidence of anastomotic stenosis remains unacceptably high at 0% to 44% . Some studies have shown a greater number of anastomotic complications associated with circular stapling (including studies in which OrVil was used) than with linear stapling …”

Section: Introductionmentioning

confidence: 99%

“…The reported incidence of anastomotic leakage ranges from 0% to 16%, and the incidence of anastomotic stenosis remains unacceptably high at 0% to 44%. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Some studies have shown a greater number of anastomotic complications associated with circular stapling (including studies in which OrVil was used) than with linear stapling. 22,23 Using the OrVil, we applied a hemi-double stapling technique (HDST) in 53 cases of LTG and encountered no anastomosis-related complications.…”

Section: Introductionmentioning

confidence: 99%

Hemi‐double stapling technique performed with a transorally inserted anvil for esophagojejunostomy in the surgical treatment of gastric cancer

Ishibashi

Oka

Kanda

et al. 2019

Introduction A transorally inserted anvil has been developed to facilitate the creation of a stapled anastomosis without the need for a purse string to secure the anvil into place during laparoscopic total gastrectomy (LTG). We describe a hemi‐double stapling technique and application of a transorally inserted anvil for esophagojejunostomy during LTG, and we report the results of a retrospective study in which we examined the feasibility and safety of this method. We also describe the key technical details of the method. Methods Our anastomotic method has four chief features: (a) the esophagus is cut at a slant, and its left cut end is cut and punched for the hemi‐double stapling technique; (b) the anvil and circular stapler are connected, placing the distal jejunum in cranial traction; (c) a single layer of sutures is used to correct dog‐earing and overlapping, and these points are completely closed with Lembert sutures; and (d) the jejunal limb is fixed to the duodenal stump to prevent kinking of the jejunal limb and to decrease tension on the anastomosis. Results This method has been used in 53 patients thus far. LTG with Roux‐en‐Y reconstruction was successful in all patients, and there was no need for conversion to open surgery. The mean operative time was 313 minutes, and the mean blood loss was 106 mL. The mean postoperative hospital stay was 18 days. There was no anastomotic leakage or stenosis. Conclusion Hemi‐double stapling technique with a transorally inserted anvil for LTG can be performed safely and easily and safely. It can also product good outcomes.