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Surgical Endoscopy

, Volume 30, Issue 7, pp 2994–3000 | Cite as

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

  • Masataka AmisakiEmail author
  • Kyoichi Kihara
  • Kanenori Endo
  • Kazunori Suzuki
  • Seiichi Nakamura
  • Takashi Sawata
  • Tetsu Shimizu
Article

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.

Keywords

Totally laparoscopic total gastrectomy Esophagojejunal anastomosis Stenosis Postoperative complication 

Notes

Acknowledgments

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

Compliance with ethical standards

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.

Supplementary material

Supplementary material 1 (AVI 95901 kb)

Supplementary material 2 (AVI 90054 kb)

References

  1. 1.
    Shehzad K, Mohiuddin K, Nizami S, Sharma H, Khan IM, Memon B, Memon MA (2007) Current status of minimal access surgery for gastric cancer. Surg Oncol 16:85–98CrossRefPubMedGoogle Scholar
  2. 2.
    Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176CrossRefPubMedGoogle Scholar
  4. 4.
    Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open versus laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–S311CrossRefPubMedGoogle Scholar
  6. 6.
    Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open versus laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173CrossRefPubMedGoogle Scholar
  7. 7.
    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
  8. 8.
    Eom BW, Kim YW, Lee SE, Ryu KW, Lee JH, Yoon HM, Cho SJ, Kook MC, Kim SJ (2012) Survival and surgical outcomes after laparoscopy-assisted total gastrectomy for gastric cancer: case-control study. Surg Endosc 26:3273–3281CrossRefPubMedGoogle Scholar
  9. 9.
    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
  10. 10.
    Kim SG, Lee YJ, Ha WS, Jung EJ, Ju YT, Jeong CY, Hong SC, Choi SK, Park ST, Bae K (2008) LATG with extracorporeal esophagojejunostomy: is this minimal invasive surgery for gastric cancer? J Laparoendosc Adv Surg Tech A 18:572–578CrossRefPubMedGoogle Scholar
  11. 11.
    Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, Yu JS, Cho SJ, Lee JY, Kim CG, Choi IJ, Kook MC, Park SR, Kim MJ, Lee JS (2009) Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol 100:392–395CrossRefPubMedGoogle Scholar
  12. 12.
    Jeong GA, Cho GS, Kim HH, Lee HJ, Ryu SW, Song KY (2009) Laparoscopy-assisted total gastrectomy for gastric cancer: a multicenter retrospective analysis. Surgery 146:469–474CrossRefPubMedGoogle Scholar
  13. 13.
    Shinohara T, Kanaya S, Taniguchi K, Fujita T, Yanaga K, Uyama I (2009) Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg 144:1138–1142CrossRefPubMedGoogle Scholar
  14. 14.
    Carboni F, Lepiane P, Santoro R, Mancini P, Lorusso R, Santoro E (2005) Laparoscopic surgery for gastric cancer: preliminary experience. Gastric Cancer 8:75–77CrossRefPubMedGoogle Scholar
  15. 15.
    Nunobe S, Hiki N, Tanimura S, Kubota T, Kumagai K, Sano T, Yamaguchi T (2011) Three-step esophagojejunal anastomosis with atraumatic anvil insertion technique after laparoscopic total gastrectomy. J Gastrointest Surg 15:1520–1525CrossRefPubMedGoogle Scholar
  16. 16.
    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
  17. 17.
    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
  18. 18.
    Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A (1999) Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 2:230–234CrossRefPubMedGoogle Scholar
  19. 19.
    Strong VE (2015) Gastric cancer: Principles and practice. In: Badwell B, Mansfield PF (eds) Open methods of resection and reconstruction for subtotal and total gastrectomy. Springer International Publishing, Switzerland, pp 199–210Google Scholar
  20. 20.
    Strong VE (2015) Gastric cancer: Principles and practice. In: Yang HK, Park J (eds) Laparoscopic methods of resection and reconstruction for subtotal and total gastrectomy with D2 lymphadenectomy. Springer International Publishing, Switzerland, pp 211–228Google Scholar
  21. 21.
    Dulucq JL, Wintringer P, Perissat J, Mahajna A (2005) Completely laparoscopic total and partial gastrectomy for benign and malignant diseases: a single institute’s prospective analysis. J Am Coll Surg 200:191–197CrossRefPubMedGoogle Scholar
  22. 22.
    Topal B, Leys E, Ectors N, Aerts R, Penninckx F (2008) Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc 22:980–984CrossRefPubMedGoogle Scholar
  23. 23.
    Mery CM, Shafi BM, Binyamin G, Morton JM, Gertner M (2008) Profiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure. Surg Obes Relat Dis 4:416–422CrossRefPubMedGoogle Scholar
  24. 24.
    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
  25. 25.
    Kong SH, Suh Y, Kwon S, Lee HJ, Kim HH, Yang HK (2013) Stable purse-string suturing using an anterior esophagotomy for reconstruction with a circular stapler during laparoscopic total gastrectomy. Asian J Endosc Surg 6:82–89CrossRefPubMedGoogle Scholar
  26. 26.
    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
  27. 27.
    Sakuramoto S, Kikuchi S, Futawatari N, Moriya H, Katada N, Yamashita K, Watanabe M (2010) Technique of esophagojejunostomy using transoral placement of the pretilted anvil head after laparoscopic gastrectomy for gastric cancer. Surgery 147:742–747CrossRefPubMedGoogle Scholar
  28. 28.
    Kachikwu EL, Trisal V, Kim J, Pigazzi A, Ellenhorn JD (2011) Minimally invasive total gastrectomy for gastric cancer: a pilot series. J Gastrointest Surg 15:81–86CrossRefPubMedGoogle Scholar
  29. 29.
    Marangoni G, Villa F, Shamil E, Botha AJ (2012) OrVil™-assisted anastomosis in laparoscopic upper gastrointestinal surgery: friend of the laparoscopic surgeon. Surg Endosc 26:811–817CrossRefPubMedGoogle Scholar
  30. 30.
    LaFemina J, Viñuela EF, Schattner MA, Gerdes H, Strong VE (2013) Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol 20:2975–2983CrossRefPubMedGoogle Scholar
  31. 31.
    Cianchi F, Macrì G, Indennitate G, Mallardi B, Trallori G, Biagini MR, Badii B, Staderini F, Perigli G (2014) Laparoscopic total gastrectomy using the transorally inserted anvil (OrVil™): a preliminary, single institution experience. Springerplus. doi: 10.1186/2193-1801-3-434 PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Masataka Amisaki
    • 1
    Email author
  • Kyoichi Kihara
    • 1
  • Kanenori Endo
    • 1
  • Kazunori Suzuki
    • 1
  • Seiichi Nakamura
    • 1
  • Takashi Sawata
    • 1
  • Tetsu Shimizu
    • 1
  1. 1.Department of SurgeryTottori Prefectural Central HospitalTottoriJapan

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