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Three-Step Esophagojejunal Anastomosis with Atraumatic Anvil Insertion Technique After Laparoscopic Total Gastrectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Esophagojejunostomy during laparoscopic total gastrectomy (LATG) using a circular stapler is a difficult procedure for which there remains no widely accepted standard technique. Based upon our experience with esophagogastrostomy during laparoscopic proximal gastrectomy, we have applied a modified lift-up method to LATG.

Material and methods

Esophagojejunostomy using a modified lift-up method was performed during LATG in 41 patients with early gastric cancer, from July 2005 to June 2010. The lift-up technique comprises three steps, which together reduce the difficulty of anvil insertion by lifting up the nasogastric tube connected to the anvil head.

Results

During the early stages of the present study, some patients who underwent LATG with the modified lift-up method developed anastomotic leakage, with stenosis occurring in two cases (4.9%) and three cases (7.3%), respectively. All patients who developed complications showed improvement following conservative treatment with no surgical procedure. The anastomotic leaks occurred during the later periods of the study. There was no mortality in the present study.

Conclusions

Our modified lift-up technique facilitates circular-stapled esophagojejunostomy in LATG and could provide a more feasible and safe option for an established procedure, especially for preventing anastomotic leak.

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Acknowledgment

The authors thank Mr. Leon Sakuma for the illustration of figures in this manuscript.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Cancer Institute Ariake Hospital, Tokyo, Japan

    Souya Nunobe, Naoki Hiki, Shinya Tanimura, Takeshi Kubota, Koshi Kumagai, Takeshi Sano & Toshiharu Yamaguchi

  2. Department of Surgery, Cancer Institute Hospital, 8–31, Ariake 3-chome, Koto-ku, Tokyo, 135-8550, Japan

    Naoki Hiki

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  1. Souya Nunobe
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  2. Naoki Hiki
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  3. Shinya Tanimura
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  4. Takeshi Kubota
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  5. Koshi Kumagai
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  6. Takeshi Sano
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  7. Toshiharu Yamaguchi
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Correspondence to Naoki Hiki.

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Nunobe, S., Hiki, N., Tanimura, S. et al. Three-Step Esophagojejunal Anastomosis with Atraumatic Anvil Insertion Technique After Laparoscopic Total Gastrectomy. J Gastrointest Surg 15, 1520–1525 (2011). https://doi.org/10.1007/s11605-011-1489-7

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  • DOI: https://doi.org/10.1007/s11605-011-1489-7

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