title: A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy.
abstract: In laparoscopy-assisted total gastrectomy, esophagojejunostomy is technically difficult. We describe a safe and simple technique for circular-stapled esophagojejunostomy. After mobilization of the stomach and the esophagus, a semicircumferential esophagotomy is made at the anterior esophageal wall. An anvil of a circular stapling device, secured with a Prolene suture (Ethicon, Inc, Somerville, NJ), is introduced via the esophagotomy. The suture is advanced anteriorly so that the center rod penetrates the esophageal wall. The esophagus is staple transected at this point. The circular-stapled esophagojejunostomy is then performed using the hemidouble stapling technique. Laparoscopy-assisted total gastrectomies were performed in 10 patients with gastric cancers. All patients were completed laparoscopically without any complications. The time of anvil placement was 9 minutes in median. Although a wound infection occurred in 1 patient, there were no major complications. There was no mortality in this series. Esophagojejunostomy using this technique is safe and simple. Its practical value is the elimination of the need for pursestring suture placement.
authors.affiliation: Department of Surgery, Osaka Police Hospital, Kitayama-cho, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Omori
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Oyama
authors.forename: Shin
authors.initials: S
authors.lastname: Mizutani
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tori
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.forename: Hiroki
authors.initials: H
authors.lastname: Akamatsu
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nakahara
authors.forename: Toshirou
authors.initials: T
authors.lastname: Nishida
mesh_terms: D000368:Aged; D004867:Equipment Design; D004946:Esophagostomy / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods*