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Comparison of single-stapling and hemi-double-stapling methods for intracorporeal esophagojejunostomy using a circular stapler after totally laparoscopic total gastrectomy

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Abstract

Background

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).

Methods

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.

Results

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).

Conclusions

Anastomosis with SST is preferred to that with hemi-DST to minimize postoperative complications.

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Acknowledgments

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, Japan

    Masataka Amisaki, Kyoichi Kihara, Kanenori Endo, Kazunori Suzuki, Seiichi Nakamura, Takashi Sawata & Tetsu Shimizu

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  1. Masataka Amisaki
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  2. Kyoichi Kihara
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  3. Kanenori Endo
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  4. Kazunori Suzuki
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Correspondence to Masataka Amisaki.

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Disclosures

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.

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Amisaki, M., Kihara, K., Endo, K. et al. Comparison of single-stapling and hemi-double-stapling methods for intracorporeal esophagojejunostomy using a circular stapler after totally laparoscopic total gastrectomy. Surg Endosc 30, 2994–3000 (2016). https://doi.org/10.1007/s00464-015-4588-9

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  • DOI: https://doi.org/10.1007/s00464-015-4588-9

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