Stapling techniques for gastric anastomoses

Abstract

After total gastrectomy it is essential that an oesophagojejunal anastomosis be constructed in the Roux-en-Y fashion. If the descending limb of the jejunum between the oesophagojejunostomy and the jejunojejunostomy measures 60–70 cm, the danger of bile refluxing into the oesophagus is eliminated. Reflux of bile produces a serious and painful oesophagitis. A side-to-end oesophagojejunal anastomosis can be constructed efficiently and safely using the EEA device if proper precautions are observed. Ideally, the cut end of the oesophagus will have a diameter sufficiently large to admit a 28-mm or 31-mm diameter EEA cartridge. If a 25-mm (EEA-25) cartridge is used, the anastomosis will be too small to accommodate passage of all of the foods generally consumed by 10–15% of patients on a regular diet. Correction requires postoperative dilatation of the stricture. In most patients, gentle dilatation of the oesophagus in the operating room will permit the passage of the EEA-28 cartridge. It is dangerous to perform vigorous dilatation as this may result in an occult tear in the lining of the oesophagus and possible postoperative leakage.