Abstract
Background
The double-stapling technique (DST) for esophagojejunostomy using the transorally inserted anvil (OrVil; Covidien Japan, Tokyo, Japan) is one of the reconstruction methods used after laparoscopy-assisted total gastrectomy (LATG). This technique has potential advantages in terms of less invasive surgery without the need to create a complicated intraabdominal anastomosis.
Methods
From 2008 to 2011, 262 patients with gastric cancer underwent total gastrectomy and reconstruction with a Roux-en-Y anastomosis, and 52 patients underwent LATG with DST. A retrospective analysis then was performed comparing the patients who experienced postoperative stenosis after LATG-DST (positive group) and the patients who did not (negative group). A comparative analysis was performed among patients comparing conventional open total gastrectomy and LATG, and multivariate analysis was performed to evaluate risk factors for the development of anastomotic stenosis.
Results
A minor leak was found in 1 patient (1.9 %), and 11 patients experienced anastomotic stenosis (21 %) after LATG with DST. Among the patients with anastomotic stenosis, three (3/4, 75 %) anastomoses were performed with the 21-mm end-to-end anastomosis (EEA) stapler, and eight anastomoses were performed (8/47, 17 %) with the 25-mm EEA stapler. The median interval to the diagnosis of anastomotic stenosis was 43 days after surgery. The patients with stenosis needed endoscopic balloon dilation an average of four times, and the rate of perforation after dilation was 13 %. The clinical and operative characteristics did not differ between the two groups. Anastomotic stenosis after open total gastrectomy occurred in two cases (0.98 %). Multivariate analysis showed that the size of the EEA stapler and the use of DST were risk factors for anastomotic stenosis.
Conclusion
Esophagojejunostomy using DST with OrVil is useful in performing a minimally invasive procedure but carries a high risk of anastomotic stenosis.
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References
Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:306–311
Husher CGS, Mingoli A, Sgarzini G, Sansonetti A, Paola MD, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 214:232–237
Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gasterectomy in early gastric cancer. Surg Endosc 19:168–173
Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open vs laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 9:1172–1176
Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727
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 25:417–420
Bracale U, Marzano E, Nastro P, Barone M, Cuccurullo D, Cutini G, Corcione F, Pignata G (2010) Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study. Surg Endosc 24:2475–2479
Kazuki 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 211:25–29
Shinohara T, Kanaya S, Taniguchi K, Fujita T, Yanaga K, Uyama I (2009) Laparoscopic total gastrecomy with D2 lymph node dissection for gastric cancer. Arch Surg 144:1138–1142
Okabe H, Obama K, Tanaka E, Nomura A, Kawamura J, Nagayama S, Itami A, Watanabe G, Kanaya S, Sakai Y (2009) Intracorporeal esophagojejunal anastomosis after gastrectomy for patients with gastric cancer. Surg Endosc 23:2167–2171
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 147:742–747
Sakuramoto S, Kikuchi S, Futawatari N, Katada N, Moriya H, Hirai K, Yamashita K, Watanabe M (2009) Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc 23:2416–2423
Usui S, Yoshida T, Ito K, Hiranuma S, Kudo S, Iwai T (2005) Laparoscopy-assisted total gastrectomy for early gastric cancer comparison with conventional open total gastrectomy. Surg Laparosc Endosc Percutan Tech 15:309–314
Mochiki E, Toyasu Y, Ogata K, Andoh H, Ohno T, Aihara R, Asao T, Kuwano H (2008) Laparoscopy-assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer. Surg Endosc 22:1997–2002
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 146:469–474
Japanese Gastric Cancer Association (2011) Japanese classification of gasatric carcinoma: 3rd English edition. Gastric Cancer 14:101–112
Clavien PA, Barkun J, Oliveira ML, Vauthey JN, Dindo D, Schulick RD, Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Volanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196
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
Fukagawa T, Gotoda T, Oda I, Deguchi Y, Saka M, Morita S, Katai H (2010) Stenosis of esophagojejuno anastomosis after gastric surgery. World J Surg 34:1859–1863
Fahad Alasfar F, Sabnis AA, Liu RC, Chand B (2009) Stricture rate after laparoscopic Roux-en-Y gastric bypass with a 21-mm circular stapler: the Cleveland clinic experience. Med Princ Pract 18:364–367
Shimada S, Matsuda M, Uno K, Matsuzaki H, Murakami S, Ogawa M (1996) A new device for the treatment of coloproctostomic stricture after double stapling anastomoses. Ann Surg 224:603–608
Bannura GC, Cumsille MAG, 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 28:921–925
Ambrosetti P, Francis K, Peyer RD, Frossard JL (2008) Colorectal anastomotic stenosis after elective laparoscopic sigmoidectomy for diverticular disease: a prospective evaluation of 68 patients. Dis Colon Rectum 51:1345–1349
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 24:2908–2912
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
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 11:233–237
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 197:13–17
Hirahara N, Tanaka T, Yano S, Yamanoi A, Minari Y, Kawabata Y, Ueda S, Hira E, Yamamoto T, Nishi T, Hyakudomi R, Inao T (2011) Reconstruction of the gastrointestinal tract by hemi-double stapling method for the esophagus and jejunum using EEA OrVil in laparoscopic total gastrectomy and proximal gastrectomy. Surg Laparosc Endosc Percutan Tech 21:11–15
Kunisaki C, Makino H, Oshima T, Fujii S, Kimura J, Takagawa R, Kosaka T, Akiyama H, Morita S, Endo I (2011) Application of the transorally anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc 25:1300–1305
Disclosures
Toru Zuiki, Yoshinori Hosoya, Yuji Kaneda, Kentaro Kurashina, Shin Saito, Takashi Ui, Hidenori Haruta, Masanobu Hyodo, Naohiro Sata, Alan T. Lefor and Yoshikazu Yasuda have no conflicts of interest or financial ties to disclose.
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Zuiki, T., Hosoya, Y., Kaneda, Y. et al. Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy. Surg Endosc 27, 3683–3689 (2013). https://doi.org/10.1007/s00464-013-2945-0
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DOI: https://doi.org/10.1007/s00464-013-2945-0