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World Journal of Surgery

, Volume 41, Issue 10, pp 2605–2610 | Cite as

Esophagojejunostomy Using the Purse-String Suturing Device After Laparoscopic Total or Proximal Gastrectomy for Gastric Cancer

  • Keisuke OkunoEmail author
  • Kentaro Gokita
  • Toshiro Tanioka
  • Norihito Ogawa
  • Sho Otsuki
  • Mikito Inokuchi
  • Toshio Takayama
  • Kazuyuki Kojima
Innovative Surgical Techniques Around the World

Abstract

Background

Performing a safe esophagojejunostomy is important for the standardization of laparoscopic total gastrectomy. We have performed intracorporeal esophagojejunostomy by a circular stapler using the purse-string suturing device that we co-developed. The advantage of this device is that it makes use of the same surgical procedure as open surgery, but it does not depend on the surgeon’s technical skills since this device does not require the laparoscopic hand-sewn technique. Furthermore, we have also adapted this device for double-tract reconstruction after laparoscopic proximal gastrectomy. In this study, we present the surgical procedures and postoperative short-term outcomes that were obtained using this novel technique.

Methods

We enrolled 94 patients that underwent intracorporeal esophagojejunostomy by circular stapler using our device after laparoscopic total or proximal gastrectomy for gastric cancer between November 2009 and October 2016.

Results

Postoperative complications related to esophagojejunostomy were due to anastomotic stenosis in two cases (2.1%) and leakage of the jejunum stump in one case (1.1%).

Conclusions

Intracorporeal esophagojejunostomy by circular stapler using the purse-string suturing device is safe and feasible. This method can be one of the standard procedures for performing intracorporeal esophagojejunostomy.

Keywords

Gastric Cancer Circular Stapler Laparoscopic Total Gastrectomy Endoscopic Balloon Dilation Laparoscopic Distal Gastrectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

LDG

Laparoscopic distal gastrectomy

LTG

Laparoscopic total gastrectomy

LPG

Laparoscopic proximal gastrectomy

PSD

Purse-string suturing device

EGJ

Esophagogastric junction

Notes

Compliance with ethical standards

Conflicts of interest

None.

Supplementary material

Supplementary material 1 (WMV 121710 kb)

References

  1. 1.
    Kitano S, Iso Y, Moriyama M et al (1994) Laparoscopy assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMedGoogle Scholar
  2. 2.
    Ohtani H, Tamamori Y, Noguchi K et al (2011) Meta-analysis of laparoscopy-assisted and open distal gastrectomy for gastric cancer. J Surg Res 171:479–485CrossRefPubMedGoogle Scholar
  3. 3.
    Katai H, Sasako M, Fukuda H et al (2010) Safety and feasibility of laparoscopic-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244CrossRefPubMedGoogle Scholar
  4. 4.
    Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112CrossRefGoogle Scholar
  5. 5.
    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRefGoogle Scholar
  6. 6.
    Inaba K, Satoh S, Ishida Y et al (2010) Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 211:e25–29CrossRefPubMedGoogle Scholar
  7. 7.
    Yamamoto M, Zaima M, Yamamoto H et al (2014) A modified overlap method using a linear stapler for intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. Hepatogastroenterology 61:543–548PubMedGoogle Scholar
  8. 8.
    Morimoto M, Kitagami H, Hayakawa T et al (2014) The overlap method is a safe and feasible for esophagojejunostomy after laparoscopic-assisted total gastrectomy. World J Surg Oncol 12:392CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kim HS, Kim MG, Kim BS et al (2013) Comparison of totally laparoscopic total gastrectomy and laparoscopic-assisted total gastrectomy methods for the surgical treatment of early gastric cancer near the gastroesophageal junction. J Laparoendosc Adv Surg Tech A 23:204–210CrossRefPubMedGoogle Scholar
  10. 10.
    Nagai E, Ohuchida K, Nakata K et al (2013) Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: inverted T-shaped anastomosis using linear staplers. Surgery 153:732–738CrossRefPubMedGoogle Scholar
  11. 11.
    Bracale U, Marzano E, Nastro P et al (2010) Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study. Surg Endosc 24:2475–2479CrossRefPubMedGoogle Scholar
  12. 12.
    Ebihara Y, Okushiba S, Kawarada Y et al (2013) Outcome of functional end-to-end esophagojejunostomy in totally laparoscopic total gastrectomy. Langenbecks Arch Surg 398:475–479CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Tsunoda S, Okabe H, Obama K et al (2014) Short-term outcomes of totally laparoscopic total gastrectomy: experience with the first consecutive 112 cases. World J Surg 38:2662–2667. doi: 10.1007/s00268-014-2611-2 CrossRefPubMedGoogle Scholar
  14. 14.
    Sakuramoto S, Kikuchi S, Futawatari N et al (2010) Technique of esophagojejunostomy using transoral placement of the pretilted anvil head after laparoscopic gastrectomy for gastric cancer. Surgery 147:742–747CrossRefPubMedGoogle Scholar
  15. 15.
    Zuiki T, Hosoya Y, Kaneda Y et al (2013) Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy. Surg Endosc 27:3683–3689CrossRefPubMedGoogle Scholar
  16. 16.
    Takiguchi S, Sekimoto M, Fujiwara Y et al (2005) A simple technique for performing laparoscopic purse-string suturing during circular stapling anastomosis. Surg Today 35:896–899CrossRefPubMedGoogle Scholar
  17. 17.
    Omori T, Oyama T, Mizutani S et al (2009) A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 197:e13–17CrossRefPubMedGoogle Scholar
  18. 18.
    Nunobe S, Hiki N, Tanimura S et al (2011) Three-step esophagojejunal anastomosis with atraumatic anvil insertion technique after laparoscopic total gastrectomy. J Gastrointest Surg 15:1520–1525CrossRefPubMedGoogle Scholar
  19. 19.
    Usui S, Nagai K, Hiranuma S et al (2008) Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument “Endo-PSI (II)” and circular stapler. Gastric Cancer 11:233–237CrossRefPubMedGoogle Scholar
  20. 20.
    Lee JH, Ahn SH, Park DJ et al (2012) Laparoscopic total gastrectomy with D2 lymphadenectomy for advanced gastric cancer. World J Surg 36:2394–2399. doi: 10.1007/s00268-012-1669-y CrossRefPubMedGoogle Scholar
  21. 21.
    Inokuchi M, Otsuki S, Fujimori Y et al (2015) Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy. World J Gastroenterol 21(32):9656–9665CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Keisuke Okuno
    • 1
    Email author
  • Kentaro Gokita
    • 1
  • Toshiro Tanioka
    • 1
  • Norihito Ogawa
    • 1
  • Sho Otsuki
    • 1
  • Mikito Inokuchi
    • 1
  • Toshio Takayama
    • 2
  • Kazuyuki Kojima
    • 1
  1. 1.Department of Gastric SurgeryTokyo Medical and Dental UniversityTokyoJapan
  2. 2.Department of Mechano-Micro EngineeringTokyo Institute of TechnologyTokyoJapan

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