title: A simple and safe method for gastrojejunostomy in laparoscopic distal gastrectomy using the hemidouble-stapling technique: efficient purse-string stapling technique.
abstract: OBJECTIVE
  To describe a simple technique for intracorporeal circular-stapled gastrojejunostomy in laparoscopic distal gastrectomy with Roux-en-Y reconstruction.
  
  
  METHODS
  After the stomach and duodenum were mobilized, gastrotomy was established in the anterior gastric wall. An anvil, which was secured with a suture needle, was inserted completely through the gastrotomy. The needle was advanced to the greater curvature of the gastric wall to enable penetration of the central rod into the gastric wall. Subsequently, the stomach was cut using a linear stapler to secure the anvil on the stomach and was sequentially transected using another linear stapler to achieve distal gastrectomy. Circular-stapled gastrojejunostomy was then performed intracorporeally using the hemidouble-stapling technique, while handling the shaft of the instrument via the umbilical incision. The jejunal stump was closed using a linear stapler.
  
  
  RESULTS
  Gastrojejunostomies were successfully performed in 20 gastric cancer patients using this technique. None of the patients showed anastomotic leakage and/or stenosis. There were no mortalities in this series.
  
  
  CONCLUSIONS
  Gastrojejunostomy performed using the above-mentioned technique was safe and simple. The most important feature of the technique was the elimination of the need for purse-string suture placement, as well as the achievement of better cosmesis using the transumbilical approach.
authors.affiliation: Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Japan. ohmori@oph.gr.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Omori
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Oyama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Akamatsu
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tori
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Ueshima
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nakahara
authors.forename: Nishida
authors.initials: N
authors.lastname: Toshirou
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*; D013536:Suture Techniques; D016896:Treatment Outcome; D014472:Umbilicus