The relationship between stapling doughnuts: characteristics and functional results after total gastrectomy.
OBJECTIVE
The objective of this study was to determine whether the thickness of the esophageal doughnut is related to postoperative results in total gastrectomy.


METHODS
Thirty-eight total gastrectomy patients were studied, including 18 who underwent jejunal pouch reconstruction and 20 who did not have pouch reconstruction. We used the Proximate-ILS circular stapler, with purse-string suturing at the cut end of the esophagus performing only the mucosal layer manually in all cases. We divided the esophageal doughnuts after stapling into two groups: Group A: doughnut involving muscle tissue of 0-25% of the esophageal circumference; Group B: doughnut involved muscle tissue of 25-100% of the esophageal circumference. Reflux scores and the scintigraphic reflux index were determined.


RESULTS
No significant difference was found between the two groups in reflux score or scintigraphic reflux index.


CONCLUSIONS
These findings indicate that the degree of postoperative reflux esophagitis was not affected by the amount of the muscular layer included in the esophageal doughnut. Continuity, and not variability of the degree of involved muscle in the esophageal doughnut, is an important factor at the time of stapling.
Fujiwara
Y
Y
The Second Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
Kusunoki
M
M
Nakagawa
K
K
Tanaka
T
T
Yamamura
T
T
Utsonomija
J
J
Sugihara
A
A
Nishigami
T
T
D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery; D011877:Radionuclide Imaging; D017792:Surgical Stapling