Summary
Background
The quality of the gastric tube commonly used for reconstruction after esophagectomy can influence postoperative progress. Moreover, formation of a gastric tube cannot generally be re-performed. To create a smooth gastric tube, various devices and two or more staplers are used; the use of two or more staplers means that an intersection exists. The intersection is inherently weak, and needs reinforcement as a potential site of leakage.
Methods
To verify the optimal orientation relative to the previous stapler, we experimented using the stomach of a pig. Difficulty was encountered inserting the stapler when orientation relative to the previous stapler was changed. The shape of the gastric wall and the staples after firing were observed.
Results
The intersection of the first and second staplers is complicated as the angle increases and the modification required to the stomach also increases. In the part that is not an intersection, almost all of the staples had a perfect form. At 0°, half of the staples had perfect forms, but the remaining half of the staples were distorted in shape. At 90°, none of the staples had perfect shape. Insertion of the stapler was easy and little modification of the stomach wall was needed with the radial stapler.
Conclusion
Herein we describe some to note at the time of gastric tube creation and our technique for the formation of a well-shaped gastric tube in which the unstapled intersection seems to maintain a natural curve and is not prone to leakage. The use of a radial stapler, in addition to a linear stapler, is a very useful and safe method for the formation of the gastric tube.
Similar content being viewed by others
References
Jean-Mare N, Abdarrahmane D, Assane N, et al. Arteriography of three models of gastric oesophagoplasty: the whole stomach, a wide gastric tube and a narrow gastric tube. Surg Radiol Anat. 2006;28:429–37.
Zhang MQ, Wu QC, Li Q, et al. Comparison of the health-related quality of life in patients with narrow gastric tube and whole stomach reconstruction after oncologic esophagectomy: a prospective randomaized study. Scand J Surg. 2013;102:77–82.
Collard JM, Tinton N, Malaise J, et al. Esophageal replacement: Gastric tube or whole stomach? Ann Thorac Surg. 1995;60:261–7.
Kimura M, Kuwabara Y, Ishiguro H, et al. A new technique for shaping the gastric tube, using both radial and linear staplers. J Am Coll Surg. 2014;219:e15–18.
Ravitch MM. Intersecting staple lines in intestinal anastomoses. Surgery. 1985;97:8–15.
Rivadeneira DE, Verdeja JC, Sonoda T. Improvement access and visibility during stapling of the ultra-low rectum: a comparative human cadaver study between two curved staplers. Ann Surg Innov Res. 2012;13:1164–6.
Kawano T, Toshino K, Endo M. Cervical esophagogastric anastomosis by the cuff technique using a stapler. J Am Coll Surg. 1996;183:157–9.
Mery CM, Shafi BM, Binyamin G, et al. Profiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure. Surg Obes Relat Dis. 2008;4:416–22.
Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14:1290–8.
Funding
The authors have no sponsorship or funding arrangements relating to the research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
M. Kimura, H. Ishiguro, T. Tanaka, and K. Mizoguchi declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Kimura, M., Ishiguro, H., Tanaka, T. et al. A method for shaping a smooth gastric tube. Eur Surg 49, 84–88 (2017). https://doi.org/10.1007/s10353-016-0454-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10353-016-0454-9