A simple technique for performing laparoscopic purse-string suturing during circular stapling anastomosis.
An esophagojejunostomy using a circular stapler requires the fixing of an anvil at the esophageal stump. When this placement procedure is laparoscopically performed, purse-string suturing is difficult, and there is a risk of loosening when a conventional needle driver is used. We herein present a simple but effective technique for performing laparoscopic purse-string suturing of the esophageal stump using a semiautomatic suturing device called the Endostitch. Gastrointestinal anvil placement was laparoscopically performed for 10 patients who underwent an esophagojejunostomy following a total gastrectomy. After the lumen of the esophagus was expanded using bowel forceps, the Endostitch was used to place approximately 12 encircling purse-string sutures. An anvil was positioned with support of the esophageal wall at three points with forceps. The Endostitch was used for the ligation with a sufficient degree of tension applied by extracorporeally pulling the sutures through the abdominal wall. The time for placement of the anvil averaged approximately 8 min. The ring formation following anastomosis was favorable in all patients. As a result, we consider our technique to be simple but very effective.
Takiguchi
Shuji
S
Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0876, Japan.
Sekimoto
Mitsugu
M
Fujiwara
Yoshiyuki
Y
Miyata
Hiroshi
H
Yasuda
Takushi
T
Doki
Yuichiro
Y
Yano
Masahiko
M
Monden
Morito
M
D000714:Anastomosis, Surgical / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005743:Gastrectomy / Q000379:methods; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D012680:Sensitivity and Specificity; D017792:Surgical Stapling; D013536:Suture Techniques