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Stable purse‐string suturing using an anterior esophagotomy for reconstruction with a circular stapler during laparoscopic total gastrectomy
Author(s) -
Kong SeongHo,
Suh Yunsuhk,
Kwon Sebastianus,
Lee HyukJoon,
Kim HyungHo,
Yang HanKwang
Publication year - 2013
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12014
Subject(s) - medicine , fibrous joint , surgery , esophagus , anastomosis , gastrectomy , laparoscopy , cancer
During a laparoscopic total gastrectomy, the combined process of purse‐string suture placement and anvil insertion of a circular stapler is one of the most difficult steps in the reconstruction. We have developed a stable and reliable technique in which purse‐string suture placement and anvil insertion using anterior esophagotomy precede complete transection of the esophagus. Methods The procedure involves tying the distal esophagus, insufflating the esophagus via a nasogastric tube, anterior wall purse‐string suture, anterior esophagotomy, posterior wall purse‐string suture, anvil insertion, fastening purse‐string suture, and transecting the esophagus. The technique has been employed in nine patients since A pril 2011. Results Eight of the nine gastrectomies were for patients with stage IA early gastric cancer and one was for a patient with medically intractable bleeding from multiple polyps. Three were men and six were women. Average BMI was 25.2 ± 5.3 (range, 16.3–33.9). Mean operation time was 276.2 ± 56.3 min (range, 215.0–395.0 min) and the mean duration for anvil insertion was 29.8 ± 7.0 min (range, 23.0–46.0 min). There were no intraoperative or postoperative anastomosis‐related complications or mortality. Conclusion Our method of anvil insertion of a circular stapler can be a good option for safe and reliable esophagojejunostomy during a laparoscopic total gastrectomy.