Semi‐end‐to‐end esophagojejunostomy after laparoscopy‐assisted total gastrectomy better reduces stricture and leakage than the conventional end‐to‐side procedure: A retrospective study

Duan, Wei; Liu, Kaijun; Fu, Xiaolong; Xuqi, Shen; Su, Chongyu; Yu, Peiwu; Zhao, Yongliang

doi:10.1002/jso.24637

Cited by 11 publications

(11 citation statements)

References 42 publications

(77 reference statements)

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“…Nevertheless, when the left side of the cut end of the esophagus (at the top of the cartridge) is cut and punched, a line of staples can be optimally placed, securing the anastomosis. When the anvil and circular stapler are connected, the distal jejunum close to the circular stapler is placed in cranial, not caudal, traction . Duan et al reported that in end‐to‐side esophagojejunostomy, the anastomosis channel and the food channel were not consistent, the diameter of circular stapler was not equal to that of the anastomotic stoma, and the distal folding intestinal wall could potentially be tacked to the anastomotic stoma, leading to stenosis . Our method, which places cranial traction on the distal jejunum during anastomosis of the esophagus and jejunum, prevents the distal intestinal wall from being tacked to the anastomotic stoma and involves no anastomotic tension that may lead to stenosis. A single‐layer of sutures is placed at points of dog‐ear formation and overlap, and these defects are completely closed with Lembert sutures to reinforce the anastomosis .…”

Section: Discussionmentioning

confidence: 93%

“…Duan et al reported that in end-to-side esophagojejunostomy, the anastomosis channel and the food channel were not consistent, the diameter of circular stapler was not equal to that of the anastomotic stoma, and the distal folding intestinal wall could potentially be tacked to the anastomotic stoma, leading to stenosis. 35 Our method, which places cranial traction on the distal jejunum during anastomosis of the esophagus and jejunum, prevents the distal intestinal wall from being tacked to the anastomotic stoma and involves no anastomotic tension that may lead to stenosis. 3.…”

Section: Anastomotic Leakagementioning

confidence: 99%

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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

Asian J Endoscop Surgery

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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.

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Section: Discussionmentioning

confidence: 93%

Section: Anastomotic Leakagementioning

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

Asian J Endoscop Surgery

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“…In addition, TLG in intracorporeal anastomosis had the advantages of high safety, less adhesion, rapid recovery, and small scars (29,30). At present, the related literature (9)(10)(11)(12)(13) reports that esophagojejunostomy is mainly performed with circular and linear staplers. In fact, a variety of techniques for esophagojejunostomy have emerged in recent years, but none of them was considered as the standard technique (31).…”

Section: Discussionmentioning

confidence: 99%

“…Currently, relevant literature (9)(10)(11)(12)(13) reports that esophagojejunostomy is mainly performed with circular and linear staplers. The former mainly includes the transorally inserted anvil (OrVil TM ), reverse puncture device (RPD), and purse-string suture method; the latter mainly includes functional end-to-end (FETE), overlap anastomosis, π-shaped esophagojejunostomy and semi-end-to-end anastomosis.…”

Section: Introductionmentioning

confidence: 99%

Esophageal Suspension Method for Hand-Sewn Esophagojejunostomy After Totally Laparoscopic Total Gastrectomy: A Simple, Safe, and Feasible Suturing Technique

et al. 2020

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Background: Totally laparoscopic total gastrectomy (TLTG) not only is difficult to operate but also has high technical requirements and a long learning curve. Therefore, it has not been widely carried out yet, and esophagojejunostomy is one of its difficulties. Relevant studies have shown that intracorporeal hand-sewn esophagojejunostomy is safe, feasible and low-cost, but it is complicated and time-consuming and requires a high-suture technique. This study introduces a simple, safe and feasible hand-sewn technique.Methods: The clinical data of 32 patients with the esophageal suspension method for hand-sewn esophagojejunostomy (suspension group) after TLTG were collected from February 2018 to June 2019. During the same period, 32 patients with traditional hand-sewn esophagojejunostomy (traditional group) after TLTG were used as the control group.Results: The operative time, anastomosis time, exhaust time and hospitalization time of the suspension group were shorter than those of the traditional group. The intraoperative blood loss in the suspension group was less than that in the traditional group. There were no postoperative complications associated with the suspension group.Conclusion: For those who have some experience in laparoscopic suture technique, the esophageal suspension method for hand-sewn esophagojejunostomy after TLTG is a simple, safe, and feasible suture technique.

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“…Ali et al [115] 2016 CS RPM 58 199.8 ± 57.0 81.6 ± 40. 3 5Wang et al [96] Duan et al [116] Lee et al [117] 2017 LS Overlap 50 144.6 ± 29.9 NA 0…”

Section: Conclusion and Prospectsmentioning

confidence: 99%

Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer

Shen¹,

Ma²,

Yang³

et al. 2019

WJGO

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Semi‐end‐to‐end esophagojejunostomy after laparoscopy‐assisted total gastrectomy better reduces stricture and leakage than the conventional end‐to‐side procedure: A retrospective study

Abstract: SETE EJ is more convenient than the conventional ETS procedure and is associated with a shorter reconstruction time and a lower incidence of EJ stricture and leakage.

Cited by 11 publications

References 42 publications

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

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

Esophageal Suspension Method for Hand-Sewn Esophagojejunostomy After Totally Laparoscopic Total Gastrectomy: A Simple, Safe, and Feasible Suturing Technique

Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer

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