Comparison of single-stapling and hemi-double-stapling methods for intracorporeal esophagojejunostomy using a circular stapler after totally laparoscopic total gastrectomy
- 689 Downloads
Laparoscopic total gastrectomy is not widely performed because of the difficulty of esophagojejunal reconstruction. This study analyzed complication rates of two different methods for reconstruction by a circular stapler after totally laparoscopic total gastrectomy (TLTG).
Between 2010 and 2014, clinical data of 19 patients who underwent TLTG for gastric adenocarcinoma were collected retrospectively. There were two methods to fix the anvil of a circular stapler into the distal esophagus: In the single-stapling technique (SST) group, Endo-PSI(II) was used for purse-suturing on the distal esophagus for reconstruction, and in the hemi-double-stapling technique (hemi-DST) group, the esophagus was cut by linear stapler with the entry hole of the anvil shaft opened after inserting the anvil tail. In both groups, surgical procedures were the same, except for the reconstruction.
All TLTGs were performed securely without mortality. Intracorporeal laparoscopic esophagojejunal anastomosis was performed successfully for all the patients. In the hemi-DST group, four patients experienced anastomotic stenosis, three of whom required endoscopic balloon dilation. In contrast, no stenosis was seen in the SST group (p = 0.033).
Anastomosis with SST is preferred to that with hemi-DST to minimize postoperative complications.
KeywordsTotally laparoscopic total gastrectomy Esophagojejunal anastomosis Stenosis Postoperative complication
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
M. Amisaki, K. Kihara, K Endo, K Suzuki, S Nakamura, T Sawata, and T. Shimizu have no conflicts of interest or financial ties to disclose.
Supplementary material 1 (AVI 95901 kb)
Supplementary material 2 (AVI 90054 kb)
- 7.Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420CrossRefPubMedGoogle Scholar
- 11.Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, Yu JS, Cho SJ, Lee JY, Kim CG, Choi IJ, Kook MC, Park SR, Kim MJ, Lee JS (2009) Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol 100:392–395CrossRefPubMedGoogle Scholar
- 19.Strong VE (2015) Gastric cancer: Principles and practice. In: Badwell B, Mansfield PF (eds) Open methods of resection and reconstruction for subtotal and total gastrectomy. Springer International Publishing, Switzerland, pp 199–210Google Scholar
- 20.Strong VE (2015) Gastric cancer: Principles and practice. In: Yang HK, Park J (eds) Laparoscopic methods of resection and reconstruction for subtotal and total gastrectomy with D2 lymphadenectomy. Springer International Publishing, Switzerland, pp 211–228Google Scholar
- 31.Cianchi F, Macrì G, Indennitate G, Mallardi B, Trallori G, Biagini MR, Badii B, Staderini F, Perigli G (2014) Laparoscopic total gastrectomy using the transorally inserted anvil (OrVil™): a preliminary, single institution experience. Springerplus. doi: 10.1186/2193-1801-3-434 PubMedPubMedCentralGoogle Scholar