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Easy method for fixation of the anvil using a one‐handed sliding‐knot technique after laparoscopic total gastrectomy
Author(s) -
Yamada Takanobu,
Shirai Junya,
Osaragi Tomohiko,
Sujishi Ken,
Kumazu Yuta,
Kamiya Mariko,
Sugano Nobuhiro,
Hatori Shinsuke,
Yoneyama Katsuya,
Kasahara Akio,
Oshima Takashi,
Yukawa Norio,
Rino Yasushi,
Yoshikawa Takaki,
Masuda Munetaka,
Yamamoto Yuji
Publication year - 2015
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.12199
Subject(s) - medicine , esophagus , surgery , knot (papermaking) , knot tying , fixation (population genetics) , gastrectomy , materials science , population , environmental health , composite material , cancer
When esophagojejunostomy is performed using a circular stapler after laparoscopic total gastrectomy, fixing the anvil to the end of the esophagus is challenging. We describe an easy method for fixation of the anvil using a one‐handed sliding‐knot technique after the anvil has been inserted into the esophagus. Materials and Surgical Technique After removing the stomach, the main operator makes a whip stitch at the end of the esophagus using a long piece of monofilament string. Both ends of the string are pulled out from the port. A knot is then made and brought close the esophagus twice (sliding granny knots). After inserting the anvil into the esophagus, the main operator pulls the main standing string with one hand, applying vibration only. This causes the knots to tighten the anvil. Then, one or two knots are added to make sure that the anvil is firmly fixed in place. In addition, we routinely add one more ligation with a ready‐made ligating loop. Discussion This method is easy and reliable, and does not require special devices or skills when performing reconstruction after laparoscopic total gastrectomy. Because of these factors, it has the potential to be widely used to perform esophagojejunostomy.