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Intracorporeal esophagojejunostomy using linear staplers in totally laparoscopic total gastrectomy
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K. Suda1,2,
I. Uyama2,
Y. Kitagawa1 |
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1Cancer Center, School of Medicine, Keio University, 2Department of Surgery, Fujita Health University |
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| Background: We have preferred using intracorporeal anastomosis with linear staplers in totally laparoscopic gastrectomy because of its handy, quick, visible, and reproducible natures. This study aimed to determine the feasibility and safety of intracorporeal esophagojejunostomy using linear staplers in totally laparoscopic total gastrectomy for advanced gastric cancer.Methods: Following laparoscopic total gastrectomy, functional end-to-end anastomosis (FEEA) and the overlap method has been used for intraabdominal and intrathoracic esophagojejunostomy, respectively. To assure the safety and reproducibility of the anastomosis and to promote food passage, the anastomosis was created to ensure good blood perfusion at the anastomotic site and full-thickness circumferentially. We created a latero-lateral anastomosis using a 45-mm stapler shaped as an isosceles right triangle, which is larger than an anastomosis created using a 25-mm circular stapler. To maintain the physiological axes of the alimentary tract, that is, to avoid twisting at the anastomosis, as much attention as possible was paid when the common entry hole was closed. The abdominal esophagus and Roux limb were fixed to the diaphragmatic crus by a few sutures to give appropriate tension to esophagojejunostomy and straighten the food pathway.Results: Early and late morbidities were 26.1% and 6.5%, respectively. Anastomotic leakage occurred in 8.7%, whereas no anastomotic stenosis took place. Internal hernia occurred in 3.3%.Conclusions: Our method of intracorporeal esophagojejunostomy using linear staplers was feasible and safe. |
Index Term 1: laparoscopic total gastrectomy
Index Term 2: intracorporeal anastomosis |
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