title: A modified stapling technique for esophagojejunostomy after total or proximal gastrectomy.
abstract: BACKGROUND
  Stapling devices reduce the leakage rate of digestive tract anastomoses, but they increase the risk of strictures. We investigated a newly modified technique of end-to-end anastomosis stapling in esophagojejunostomy after total or proximal gastrectomy.
  
  
  METHODS
  A modified stapling technique (using a stapled anastomosis between esophageal mucosal and intact jejunal layers, with hand-sewn seromuscular sutures between the esophagus and jejunum) was used in 21 patients (modified group), while a conventionally stapled anastomosis was performed in 17 patients (conventional group). The incidence and severity of dysphagia and the size of the anastomosis as determined from x ray films were compared in the two groups.
  
  
  RESULTS
  The modified technique provided significantly better results for dysphagia severity than the conventional method (p = 0.0025). Most of the patients in the modified group had mild dysphagia, and most patients in the conventional group complained of moderate or severe dysphagia. In the modified group, the inner diameter of the anastomosis was 12.1 +/- 2.5 mm, significantly larger than that in the conventional group (10.0 +/- 1.8 mm; p = 0.009).
  
  
  CONCLUSIONS
  The use of our modified stapling technique can minimize the risk of anastomotic stricture and the feeling of dysphagia after esophagojejunostomy.
authors.affiliation: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Matsushita
authors.forename: A
authors.initials: A
authors.lastname: Sugiyama
authors.forename: H
authors.initials: H
authors.lastname: Saito
authors.forename: F
authors.initials: F
authors.lastname: Maruta
authors.forename: K
authors.initials: K
authors.lastname: Ishida
authors.forename: H
authors.initials: H
authors.lastname: Aruga
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
authors.forename: S
authors.initials: S
authors.lastname: Kawasaki
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000517:prevention & control; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control; D004946:Esophagostomy / Q000379:methods*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017792:Surgical Stapling / Q000379:methods*