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20.10.2015 | Ausgabe 7/2016

Surgical Endoscopy 7/2016

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

Zeitschrift:
Surgical Endoscopy > Ausgabe 7/2016
Autoren:
Masataka Amisaki, Kyoichi Kihara, Kanenori Endo, Kazunori Suzuki, Seiichi Nakamura, Takashi Sawata, Tetsu Shimizu
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00464-015-4588-9) contains supplementary material, which is available to authorized users.

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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Zusatzmaterial
Supplementary material 1 (AVI 95901 kb)
Supplementary material 2 (AVI 90054 kb)
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