Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 355–355 | Cite as

A Simple and Reliable Method for Intracorporeal Circular-Stapled Esophagojejunostomy Using a Hand-Sewn Over-and-Over Suture Technique in Laparoscopic Total Gastrectomy

  • Takeru Matsuda
  • Takeshi Iwasaki
  • Masaaki Mitsutsuji
  • Kenro Hirata
  • Daisuke Tsugawa
  • Yutaka Sugita
  • Etsuji Shimada
  • Yoshihiro Kakeji
Gastrointestinal Oncology

Abstract

Background

The controversy regarding laparoscopic total gastrectomy (LTG) is mainly due to the difficulty associated with esophagojejunostomy during this procedure. Although several techniques have so far been reported to overcome this issue,1 4 a reliable technique has not yet been established. We developed intracorporeal esophagojejunostomy using a circular stapler in LTG with a hand-sewn over-and-over suture technique, and have shown its favorable outcomes compared with those of conventional open surgery.5 This technique is presented in the video.

Methods

After transection of the esophagus, an over-and-over suture with a 2-0 monofilament is placed counterclockwise from the right to the left side of the cut end in an outside-to-inside direction, and then from the left to the right side in an inside-to-outside direction. After insertion of the anvil head into the esophagus, it was fixed by ligation of the thread. Finally, intracorporeal esophagojejunal anastomosis was performed using a circular stapler.

Results

In LTG, reconstruction using this method was performed for 23 consecutive patients with gastric cancer. There were no serious intraoperative complications or need for conversion to open surgery. Anastomotic leakage and stenosis occurred in one case each, respectively. The mean time for fixation of the anvil to the esophagus was 15 min for the last 12 consecutive patients.

Conclusions

This method is simple and feasible, and the advantage of this technique is the elimination of the backhand stroke throughout the suturing procedure.

Keywords

Gastric Cancer Anastomotic Leakage Suture Technique Stapling Anastomosis Laparoscopic Total Gastrectomy 

Supplementary material

10434_2015_4541_MOESM1_ESM.mpg (125.6 mb)
Supplementary material 1 (MPG 128614 kb)

References

  1. 1.
    Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg. 2010;211: e25–9.PubMedCrossRefGoogle Scholar
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    Kinoshita T, Oshiro T, Ito K, Shibasaki H, Okazumi S, Katoh R. Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy. Surg Endosc. 2010;24:2908–12.PubMedCrossRefGoogle Scholar
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    Omori T, Oyama T, Mizutani S, et al. A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg. 2009;197: e13–7.PubMedCrossRefGoogle Scholar
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    Takiguchi S, Sekimoto M, Fujiwara Y, et al. A simple technique for performing laparoscopic purse-string suturing during circular stapling anastomosis. Surg Today. 2005;35:896–9.PubMedCrossRefGoogle Scholar
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    Matsuda T, Iwasaki T, Mitsutsuji M, et al. Surgical outcomes of intracorporeal circular-stapled esophagojejunostomy using modified over-and-over suture technique in laparoscopic total gastrectomy. Surg Endosc. 2015.Google Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Takeru Matsuda
    • 1
  • Takeshi Iwasaki
    • 1
  • Masaaki Mitsutsuji
    • 1
  • Kenro Hirata
    • 1
  • Daisuke Tsugawa
    • 1
  • Yutaka Sugita
    • 1
  • Etsuji Shimada
    • 1
  • Yoshihiro Kakeji
    • 2
  1. 1.Department of SurgeryNational Hospital Organization Kobe Medical CenterKobeJapan
  2. 2.Division of Gastrointestinal Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeJapan

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