Advertisement

Surgical Endoscopy

, Volume 29, Issue 11, pp 3386–3391 | Cite as

Surgical outcomes of intracorporeal circular-stapled esophagojejunostomy using modified over-and-over suture technique in laparoscopic total gastrectomy

  • Takeru MatsudaEmail author
  • Takeshi Iwasaki
  • Masaaki Mitsutsuji
  • Kenro Hirata
  • Yoko Maekawa
  • Daisuke Tsugawa
  • Yutaka Sugita
  • Etsuji Shimada
  • Yoshihiro Kakeji
Dynamic Manuscript

Abstract

Background

Esophagojejunostomy in laparoscopic total gastrectomy (LTG) is a technically demanding procedure. Although several methods have been reported to date, none is considered consistently reliable. We developed a simple method for intracorporeal circular-stapled esophagojejunostomy using a modified over-and-over suture technique. The surgical outcomes of our technique were evaluated in comparison with those of open total gastrectomy (OTG).

Methods

From April 2012 to August 2014, reconstruction using this method in LTG was performed for 21 consecutive patients with gastric cancer (LTG group). Their surgical outcomes were compared with those of 27 patients with gastric cancer who underwent OTG without splenectomy (OTG group) between January 2011 and April 2014.

Results

Estimated blood loss was significantly lower, and the postoperative hospital stay was significantly shorter in the LTG group than in the OTG group. The operating time and the number of harvested lymph nodes were similar between the two groups. The incidence of overall complications did not differ significantly between the two groups. Anastomotic leakage developed in one of the 21 patients in the LTG group and in two of the 27 patients in the OTG group. Anastomotic stenosis was observed in one patient in the LTG group.

Conclusions

We consider this method as simple and feasible for most laparoscopic surgeons with basic laparoscopic suturing skills. This method might help LTG to become an accepted standard surgical option for treatment of patients with gastric cancer.

Keywords

Esophagojejunostomy Laparoscopy Gastric cancer 

Notes

Disclosures

Takeru Matsuda, Takeshi Iwasaki, Masaaki Mitsutsuji, Kenro Hirata, Yoko Maekawa, Daisuke Tsugawa, Yutaka Sugita, Etsuji Shimada, and Yoshihiro Kakeji have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 51803 kb)

Supplementary material 2 (WMV 44959 kb)

Supplementary material 3 (WMV 35646 kb)

References

  1. 1.
    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMedGoogle Scholar
  2. 2.
    Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report–a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420CrossRefPubMedGoogle Scholar
  3. 3.
    Kodera Y, Fujiwara M, Ohashi N, Nakayama G, Koike M, Morita S, Nakao A (2010) Laparoscopic surgery for gastric cancer: a collective review with meta-analysis of randomized trials. J Am Coll Surg 211:677–686CrossRefPubMedGoogle Scholar
  4. 4.
    Lee JH, Han HS (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173CrossRefPubMedGoogle Scholar
  5. 5.
    Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C (2007) Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg 194:839–844 (discussion 844)CrossRefPubMedGoogle Scholar
  6. 6.
    Tanimura S, Higashino M, Fukunaga Y, Kishida S, Ogata A, Fujiwara Y, Osugi H (2007) Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Br J Surg 94:204–207CrossRefPubMedGoogle Scholar
  7. 7.
    Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, Uyama I (2010) Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 211:e25–e29CrossRefPubMedGoogle Scholar
  8. 8.
    Kinoshita T, Oshiro T, Ito K, Shibasaki H, Okazumi S, Katoh R (2010) Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy. Surg Endosc 24:2908–2912CrossRefPubMedGoogle Scholar
  9. 9.
    Omori T, Oyama T, Mizutani S, Tori M, Nakajima K, Akamatsu H, Nakahara M, Nishida T (2009) A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 197:e13–e17CrossRefPubMedGoogle Scholar
  10. 10.
    Takiguchi S, Sekimoto M, Fujiwara Y, Miyata H, Yasuda T, Doki Y, Yano M, Monden M (2005) A simple technique for performing laparoscopic purse-string suturing during circular stapling anastomosis. Surg Today 35:896–899CrossRefPubMedGoogle Scholar
  11. 11.
    Usui S, Nagai K, Hiranuma S, Takiguchi N, Matsumoto A, Sanada K (2008) Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument “Endo-PSI (II)” and circular stapler. Gastric Cancer 11:233–237CrossRefPubMedGoogle Scholar
  12. 12.
    Kanaji S, Harada H, Nakayama S, Yasuda T, Oshikiri T, Kawasaki K, Yamamoto M, Imanishi T, Nakamura T, Suzuki S, Tanaka K, Fujino Y, Tominaga M, Kakeji Y (2014) Surgical outcomes in the newly introduced phase of intracorporeal anastomosis following laparoscopic distal gastrectomy is safe and feasible compared with established procedures of extracorporeal anastomosis. Surg Endosc 28:1250–1255CrossRefPubMedGoogle Scholar
  13. 13.
    Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195:284–287CrossRefPubMedGoogle Scholar
  14. 14.
    Hiki N, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Ohyama S, Seto Y, Muto T (2007) Laparoscopic esophagogastric circular stapled anastomosis: a modified technique to protect the esophagus. Gastric Cancer 10:181–186CrossRefPubMedGoogle Scholar
  15. 15.
    Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc 23:2624–2630CrossRefPubMedGoogle Scholar
  16. 16.
    Bannura GC, Cumsille MA, Barrera AE, Contreras JP, Melo CL, Soto DC (2004) Predictive factors of stenosis after stapled colorectal anastomosis: prospective analysis of 179 consecutive patients. World J Surg 28:921–925CrossRefPubMedGoogle Scholar
  17. 17.
    Zuiki T, Hosoya Y, Kaneda Y, Kurashina K, Saito S, Ui T, Haruta H, Hyodo M, Sata N, Lefor AT, Yasuda Y (2013) Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy. Surg Endosc 27:3683–3689CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Takeru Matsuda
    • 1
    Email author
  • Takeshi Iwasaki
    • 1
  • Masaaki Mitsutsuji
    • 1
  • Kenro Hirata
    • 1
  • Yoko Maekawa
    • 1
  • Daisuke Tsugawa
    • 1
  • Yutaka Sugita
    • 1
  • Etsuji Shimada
    • 1
  • Yoshihiro Kakeji
    • 2
  1. 1.Department of SurgeryNational Hospital Organization Kobe Medical CenterKobeJapan
  2. 2.Division of Gastrointestinal Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeJapan

Personalised recommendations