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Xu X, Huang C, Mou Y, Zhang R, Pan Y, Chen K, Lu C. Intra-corporeal hand-sewn esophagojejunostomy is a safe and feasible procedure for totally laparoscopic total gastrectomy: short-term outcomes in 100 consecutive patients. Surg Endosc 2017; 32:2689-2695. [PMID: 29101569 DOI: 10.1007/s00464-017-5964-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND An optimal method for intracorporeal esophagojejunostomy has not yet been standardized. This study sought to introduce intracorporeal hand-sewn end-to-side esophagojejunostomy after totally laparoscopic total gastrectomy. METHODS The author conducted a consecutive series of 100 intracorporeal hand-sewn esophagojejunostomies after totally laparoscopic total gastrectomy for upper third gastric cancer from September 2012 to December 2016. RESULTS All patients were successfully operated on without conversion to open- or laparoscope-assisted surgery. The mean reconstruction time was 45 min, and the time until first flatus was 4 days. The time to start a soft diet was 7 days. The length of postoperative hospital stay was 8 days. The overall postoperative morbidity was 8%, including one anastomotic leak, and the mortality was zero. The median follow-up duration was 13 months; no anastomotic strictures were encountered. CONCLUSIONS Intracorporeal hand-sewn end-to-side esophagojejunostomy after totally laparoscopic total gastrectomy is a safe and feasible procedure. This method can identify negative margins with intraoperative frozen sections before reconstruction and could be a good option for performing intracorporeal esophagojejunostomy with an advanced endoscopic suture technique.
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Affiliation(s)
- Xiaowu Xu
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Chaojie Huang
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Yiping Mou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China.
| | - Renchao Zhang
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Ke Chen
- School of Medicine, Zhejiang University, Hangzhou, 310029, Zhejiang, China
| | - Chao Lu
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
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Fukagawa T, Gotoda T, Oda I, Deguchi Y, Saka M, Morita S, Katai H. Stenosis of esophago-jejuno anastomosis after gastric surgery. World J Surg 2010; 34:1859-63. [PMID: 20458580 DOI: 10.1007/s00268-010-0609-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Stenosis of esophago-jejuno anastomosis is one of the postoperative complications of gastric surgery. This complication usually manifests with the symptom of dysphagia and is treated by endoscopic dilatation. No large-scale studies have been conducted to determine the incidence of this complication after surgery. METHODS The data of a total of 1478 consecutive patients who underwent total, proximal, or completion gastrectomy, including esophago-jejuno anastomosis, between 2000 and 2008 were analyzed retrospectively with a view to determining the incidence of anastomotic stenosis. RESULTS Sixty patients (4.1%) developed stenosis of the esophago-jejuno anastomosis which needed to be treated by endoscopic balloon dilatation. The average interval between the surgery and detection of stenosis was 67.4 days (median = 58.0). Multivariate analysis identified female gender, proximal gastrectomy, use of a narrow-sized stapler, and the choice of the stapling device as significant factors influencing the risk of development of anastomotic stenosis. CONCLUSION Esophago-jejuno anastomotic stenosis appears to be a common late postoperative complication after gastric surgery. Endoscopic examination and treatment yielded favorable outcomes in patients complaining of dysphagia after gastric surgery.
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Affiliation(s)
- Takeo Fukagawa
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, Japan.
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New double-stapling technique for esophagojejunostomy and esophagogastrostomy in gastric cancer surgery, using a peroral intraluminal approach with a digital stapling system. Gastric Cancer 2009; 12:101-5. [PMID: 19562464 DOI: 10.1007/s10120-009-0510-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 04/18/2009] [Indexed: 02/07/2023]
Abstract
In the abdominal-transhiatal approach for resection of adenocarcinoma of the cardia or subcardia, and in laparoscopy-assisted total gastrectomy (LATG), the use of a circular stapling device has potential problems with the placement of the purse-string suture and insertion of the anvil of the instrument. We describe a new double-stapling technique for esophagojejunostomy and esophagogastrostomy, using a peroral intraluminal approach with a digital stapling system, a flexible shaft remote-control stapler - the Surg-ASSIST and Power Circular Stapler 21 mm (PCS). The overtube of the flexible shaft of the PCS is prepared with a nylon tie and secured to a nasogastric (NG) tube. The flexible shaft is manually advanced down the esophagus with guidance by pulling the NG tube from the abdominal cavity side. The trocar of the flexible shaft is removed from the stump of the abdominal esophagus and connected to the anvil and they are approximated; the stapler device is then fired to form a double-stapled esophagojejunostomy and esophagogastrostomy. Our peroral intraluminal approach does not require a suturing technique, and it can make anastomosis after resection for carcinoma of the esophagogastric junction and after LATG safe and simple.
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Matsui H, Uyama I, Sugioka A, Fujita J, Komori Y, Ochiai M, Hasumi A. Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy. Am J Surg 2002; 184:58-60. [PMID: 12135722 DOI: 10.1016/s0002-9610(02)00893-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Circular stapling devices are commonly used to form esophagojejunal anastomoses after total gastrectomy. However, the technique has potential problems with placement of the purse-string suture and insertion of the anvil of the instrument. METHODS We describe an improved technique for esophagojejunostomy by functional end-to-end anastomosis with linear stapling devices. RESULTS Three patients with gastric cancer underwent this procedure after total gastrectomy. No anastomotic leakage or clinical evidence of stenosis was encountered. The maximum diameters of the anastomoses, evaluated by radiography with barium at 6 months after surgery, were 3.5 cm and 4.0 cm in 2 patients. Endoscopic examination revealed clear lines of anastomosis with a straight continuity between the distal esophagus and the jejunum. CONCLUSIONS Our improved technique for esophagojejunostomy by functional end-to-end anastomosis with two linear staplers is a convenient, safe and reliable procedure that is independent of the width of the esophagus and the depth of the esophageal hiatus.
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Affiliation(s)
- Hideo Matsui
- Department of Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi 470-1192, Japan.
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Machado MA, Herman P, Montagnini AL, Costa ML, Machado MC. Modified technique for esophagojejunostomy after total gastrectomy. J Surg Oncol 2001; 78:148-50. [PMID: 11579397 DOI: 10.1002/jso.1138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- M A Machado
- Department of Abdominal Surgery, Cancer Hospital, São Paulo, Brazil.
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Ustündag Y, Köseoglu T, Cetin F, Eroglu A, Soran A, Eskioglu E. Self-expandable metallic stent therapy of esophagojejunal stricture in a stapled anastomosis: a case report and review of the literature. Dig Surg 2001; 18:211-3. [PMID: 11464011 DOI: 10.1159/000050131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The introduction of the stapler apparatus has provided safe and effective gastrointestinal anastomotic surgical operations for most surgeons. However, the major disadvantage of stapler surgery is an increased risk of anastomotic stricture formation. Treatment of this kind of stricture is performed mainly by using endoscopic balloon dilators. However, this therapy may fail or the patient may become reactive or uncooperative during dilatation sessions. Herein, we present a case to show the successful and uncomplicated insertion of a self-expanding metallic stent into an esophagojejunal anastomotic stricture which developed 1 month after total gastrectomy and stapled esophagojejunal anastomosis in a patient with gastric carcinoma. This is the 3rd report in the literature.
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Affiliation(s)
- Y Ustündag
- 2nd Gastroenterology Clinic, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
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Parker J, Sell H, Stahlfeld K. A new technique for esophagojejunostomy after total gastrectomy for gastric cancer. Am J Surg 2001; 182:174-6. [PMID: 11574091 DOI: 10.1016/s0002-9610(01)00671-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The critical part of any operation involving a proximal gastric resection is the esophageal anastomosis. Leakage from this anastomosis is one of the main reasons for postoperative morbidity and death after gastrectomy. Application of the double-stapling technique affords many of the same advantages that it does for low rectal tumors, especially in obese patients with narrow costal margins. METHODS A new technique for esophagojejunostomy after total gastrectomy for gastric cancer is described. RESULTS This technique has been used in 3 patients. At a follow-up of 22 months, there have been no anastomotic leaks or evidence of clinical stenoses. CONCLUSIONS This technique minimizes manipulation and dissection around the distal esophagus. Not only does this make the operation easier, but it also allows for a longer proximal resection margin. Possibly this will result in lower rates of esophageal breakdown.
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Affiliation(s)
- J Parker
- Department of Surgery, Mercy Hospital of Pittsburgh, 1400 Locust St., Pittsburgh, PA 15219, USA
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