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Surgical Endoscopy

, Volume 33, Issue 7, pp 2128–2134 | Cite as

Stenosis after esophagojejunostomy with the hemi-double-stapling technique using the transorally inserted anvil (OrVil™) in Roux-en-Y reconstruction with its efferent loop located on the patient’s left side following laparoscopic total gastrectomy

  • Takaya TokuharaEmail author
  • Eiji Nakata
  • Toshiyuki Tenjo
  • Isao Kawai
  • Keisaku Kondo
  • Hirofumi Ueda
  • Atsushi Tomioka
Article
  • 115 Downloads

Abstract

Background

The drawback of intracorporeal esophagojejunostomy with the double-stapling technique (DST) using a transorally inserted anvil (OrVil™, Covidien, Mansfield, MA, USA) following laparoscopic total gastrectomy (LTG) is not only the high incidence of stenosis but also the presence of intractable stenosis that is refractory to endoscopic treatments.

Methods

From November 2013 to December 2016, 24 patients with gastric cancer underwent intracorporeal circular-stapled esophagojejunostomy with the hemi-double-stapling technique (hemi-DST) using the OrVil™ in antecolic Roux-en-Y reconstruction with its efferent loop located on the left side of the patient following LTG to prevent twisting of the esophagojejunostomy and lifted jejunum, which might cause intractable stenosis of the esophagojejunostomy.

Results

In this patient series, no twisting of the esophagojejunostomy and lifted jejunum was encountered intraoperatively or postoperatively. Two stenoses of the esophagojejunostomy occurred. Because neither was involved with twisting and both were localized at the anastomotic plane, endoscopic treatments including balloon dilation and electrocautery incisional therapy were successful in both cases. There were no patients with intractable stenosis in this series.

Conclusions

Intracorporeal esophagojejunostomy with the hemi-DST using the OrVil™ in antecolic Roux-en-Y reconstruction with its efferent loop located on the left side of the patient can be one option for a circular stapling technique in LTG due to its prevention of intractable stenosis of the esophagojejunostomy that is refractory to endoscopic treatments.

Keywords

Gastric cancer Laparoscopic total gastrectomy Roux-en-Y reconstruction OrVil™ Twisting of the esophagojejunostomy Intractable stenosis 

Notes

Compliance with ethical standards

Disclosures

Drs. Takaya Tokuhara, Eiji Nakata, Toshiyuki Tenjo, Isao Kawai, Keisaku Kondo, Hirofumi Ueda, and Atsushi Tomioka have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Takaya Tokuhara
    • 1
    Email author
  • Eiji Nakata
    • 1
  • Toshiyuki Tenjo
    • 1
  • Isao Kawai
    • 1
  • Keisaku Kondo
    • 1
  • Hirofumi Ueda
    • 1
  • Atsushi Tomioka
    • 1
  1. 1.Department of SurgeryOtori Stomach and Intestines HospitalSakaiJapan

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