Skip to main content

Significance of intraoperative endoscopy in total gastrectomy for gastric cancer

Surgical Endoscopy volume 24, pages 2633–2636 (2010)Cite this article

Abstract

Background

Anastomotic impairment can be a major cause of surgical complications in gastrointestinal surgery. The aim of this study was to evaluate the efficacy of intraoperative endoscopy (IOE) in esophagojejunal anastomosis for detection of anastomotic impairment.

Methods

Forty-eight patients who underwent total gastrectomy were evaluated for the integrity of the esophagojejunostomy using IOE at completion of mechanical esophagojejunal anastomosis.

Results

Overall postoperative anastomotic leakage (PAL) rate was 4.2% (n = 2/48). Both patients who developed PAL had abnormal findings such as mucosal defect in the esophageal mucosa or incomplete anastomotic stapling. Also, IOE revealed inadvertent anastomotic failure in three patients: two jejunal and one esophageal occlusion. There were no complications due to IOE.

Conclusion

IOE is safe and may easily provide significant information that can minimize PAL by detecting anastomotic failure on esophagojejunal anastomosis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Panieri E, Dent DM (2003) Implications of anastomotic leakage after total gastrectomy for gastric carcinoma. S Afr J Surg 41:66–69

    PubMed  Google Scholar 

  2. Lamb PJ, Griffin SM, Chandrashekar MV, Richardson DL, Karat D, Hayes N (2004) Prospective study of routine contrast radiology after total gastrectomy. Br J Surg 91:1015–1019

    CAS  Article  PubMed  Google Scholar 

  3. Hyodo M, Hosoya Y, Hirashima Y, Haruta H, Kurashina K, Saito S, Yokoyama T, Arai W, Zuiki T, Yasuda Y, Nagai H (2007) Minimum leakage rate (0.5%) of stapled esophagojejunostomy with sacrifice of a small part of the jejunum after total gastrectomy in 390 consecutive patients. Dig Surg 24:169–172

    CAS  Article  PubMed  Google Scholar 

  4. Isozaki H, Okajima K, Ichinona T, Hara H, Fujii K, Nomura E (1997) Risk factors of esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer. Hepatogastroenterology 44:1509–1512

    CAS  PubMed  Google Scholar 

  5. Law WL, Choi HK, Lee YM, Ho JW, Seto CL (2007) Anastomotic leakage is associated with long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg 11:8–15

    Article  PubMed  Google Scholar 

  6. Yeh CY, Changchien CR, Wang JY, Chen JS, Chen HH, Chiang JM, Tang R (2005) Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 241:9–13

    PubMed  Google Scholar 

  7. Chambers WM, McC Mortensen NJ (2004) Postoperative leakage and abscess formation after colorectal surgery. Best Pract Res Clin Gastroenterol 18:865–880

    CAS  PubMed  Google Scholar 

  8. Pakkastie TE, Luukkonen PE, Järvinen HJ (1994) Anastomotic leakage after anterior resection of the rectum. Eur J Surg 160:293–297

    CAS  PubMed  Google Scholar 

  9. Briel JW, Tamhankar AP, Hagen JA, DeMeester SR, Johansson J, Choustoulakis E, Peters JH, Bremner CG, DeMeester TR (2004) Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 199:667–668

    Article  Google Scholar 

  10. Sakanoue Y, Nakao K, Shoji Y, Yanagi H, Kusunoki M, Utsunomiya J (1993) Intraoperative colonoscopy. Surg Endosc 7:84–87

    CAS  Article  PubMed  Google Scholar 

  11. Zmora O, Dinnewitzer AJ, Pikarsky AJ, Efron JE, Weiss EG, Nogueras JJ, Wexner SD (2002) Intraoperative endoscopy in laparoscopic colectomy. Surg Endosc 16:808–811

    CAS  Article  PubMed  Google Scholar 

  12. Champion JK, Hunt T, DeLisle N (2002) Role of routine intraoperative endoscopy in laparoscopic bariatric surgery. Surg Endosc 16:1663–1665

    CAS  Article  PubMed  Google Scholar 

  13. Shin RB (2004) Intraoperative endoscopic test resulting in no postoperative leaks from the gastric pouch and gastrojejunal anastomosis in 366 laparoscopic Roux-en-Y gastric bypasses. Obes Surg 14:1067–1069

    Article  PubMed  Google Scholar 

  14. Sekhar N, Torquati A, Lutfi R, Richards WO (2006) Endoscopic evaluation of the gastrojejunostomy in laparoscopic gastric bypass: a series of 340 patients without postoperative leak. Surg Endosc 20:199–201

    CAS  Article  PubMed  Google Scholar 

  15. Espiner HJ, Salmon PR, Teague RH, Read AE (1973) Operative colonoscopy. Br Med J 24:453–454

    Article  Google Scholar 

  16. Martin PJ, Forde KA (1978) Intraoperative colonoscopy: preliminary report. Dis Colon Rectum 22:234–237

    Article  Google Scholar 

  17. Kaibara N, Kimura O, Nishidoi H, Miyano Y, Koga S (1982) Intraoperative colonoscopy for the diagnosis of multiple cancers of the large intestine. Jpn J Surg 12:117–121

    CAS  Article  PubMed  Google Scholar 

  18. Cohen JL, Forde KA (1988) Intraoperative colonoscopy: preliminary report. Ann Surg 207:231–233

    CAS  Article  PubMed  Google Scholar 

  19. Whelan RL, Buls JG, Goldberg SM, Rothenberger DA (1989) Intra-operative endoscopy: University of Minnesota experience. Am Surg 55:281–286

    CAS  PubMed  Google Scholar 

  20. Beard JD, Nicholson ML, Sayers RD, Lloyd D, Everson NW (1990) Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial. Br J Surg 77:1095–1097

    CAS  Article  PubMed  Google Scholar 

Download references

Disclosures

K. Nishikawa, K. Yanaga, H. Kashiwagi, N. Hanyuu, and S. Iwabuchi have no conflicts of interest or financial ties to disclose.

Author information

Affiliations

  1. Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi Minato-ku, Tokyo, 105-8471, Japan

    Katsunori Nishikawa, Katsuhiko Yanaga & Hideyuki Kashiwagi

  2. Division of Surgery, Machida Municipal Hospital, 2-15-41 Asahimachi, Machida-shi, Tokyo, 194-0023, Japan

    Nobuyoshi Hanyuu & Shuuichi Iwabuchi

Authors
  1. Katsunori Nishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katsuhiko Yanaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hideyuki Kashiwagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nobuyoshi Hanyuu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shuuichi Iwabuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katsunori Nishikawa.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Nishikawa, K., Yanaga, K., Kashiwagi, H. et al. Significance of intraoperative endoscopy in total gastrectomy for gastric cancer. Surg Endosc 24, 2633–2636 (2010). https://doi.org/10.1007/s00464-010-1007-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1007-0

Keywords

  • Intraoperative endoscopy
  • Gastric cancer
  • Anastomotic impairment
  • Esophagojejunostomy