Abstract
Background
Laparoscopic total gastrectomy (LTG) has not gained widespread acceptance because of technical difficulties, especially esophagojejunal anastomosis. Various modified procedures for reconstruction have been reported, but an optimal method has not been established. The authors report a circular-stapled anastomosis using hand-sewn purse-string sutures, which is a simple and classic method. However, no previous study has assessed its reliability.
Methods
From September 2008 to May 2009, 10 consecutive patients (9 men and 1 woman) with gastric cancer underwent LTG at the authors’ institution. These patients had a median age of 63.7 years (range, 45–80 years) and a body mass index of 22.4 kg/m2 (range, 18–26 kg/m2). After transection of the abdominal esophagus, a hand-sewn purse-string suture along the cut end of the esophagus was performed using 3-0 monofilament thread. An anvil head then was inserted into the esophagus, and the thread was tied. A monofilament pretied loop suture was added to reinforce the ligation. After the creation of an Roux-en-Y jejunal limb, laparoscopic esophagojejunal anastomosis was performed using a circular stapler inserted via a surgical glove attached to a wound retractor at the incision point at the umbilicus. The jejunal stump was closed with an endoscopic linear stapler.
Results
Laparoscopic esophagojejunostomy was performed successfully for all the patients. No postoperative complications related to anastomosis occurred. In one patient, an intraabdominal abscess developed postoperatively and was treated conservatively. The mean operation time was 257 min, and the estimated blood loss was 69 ml.
Conclusions
With the described method, esophagojejunostomy can be performed as in conventional open surgery. Hand-sewn purse-string suturing is demanding technically, but it can be performed safely by experienced laparoscopic surgeons. This technique is feasible and can lower the cost of the laparoscopic procedure. It may be considered in countries with limited access to other special devices.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
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 16:85–98
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 245:68–72
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
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 94:204–207
Okabe H, Satoh S, Inoue H, Kondo M, Kawamura J, Nomura A, Nagayama S, Hasegawa S, Itami A, Watanabe G, Sakai Y (2007) Esophagojejunostomy through minilaparotomy after laparoscopic total gastrectomy. Gastric Cancer 10:176–180
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 18:572–578
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 35:896–899
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 10:181–186
Usui S, Nagai K, Hiranuma S, Takiguchi N, Matsumoto A, Sanada (2008) Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument “Endo-PSI (II)” and circular stapler. Gastric Cancer 11:233–237
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–e17
Okabe H, Obama K, Tanaka E, Nomura A, Kawamura JI, Nagayama S, Itami A, Watanabe G, Kanaya S, Sakai Y (2009) Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc 23:2167–2171
Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc. doi:10.1007/s00464-009-0461-z
Sakaguchi Y, Ikeda O, Toh Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, Ohga T, Adachi E, Okamura T (2008) New technique for the retraction of the liver in laparoscopic gastrectomy. Surg Endosc 22:2532–2534
Ruiz-de-Adana JC, López-Herrero J, Hernández-Matías A, Colao-Garcia L, Muros-Bayo JM, Bertomeu-Garcia A, Limones-Esteban M (2008) Laparoscopic hand-sewn gastrojejunal anastomoses. Obes Surg 18:1074–1076
Acknowledgments
We thank Mr. Shigeyuki Sakaguchi for his preparation of the schematic illustrations.
Disclosures
Takahiro Kinoshita, Takashi Oshiro, Katsuhiko Ito, Hidehito Shibasaki, Shinichi Okazumi, and Ryoji Katoh have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kinoshita, T., Oshiro, T., Ito, K. et al. Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy. Surg Endosc 24, 2908–2912 (2010). https://doi.org/10.1007/s00464-010-1041-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-1041-y