[Transabdominal and transhiatal esophagogastrostomy or esophagojejunostomy using novel double stapling technique].
OBJECTIVE
To explore the techniques of esophagogastrostomy or esophagojejunostomy in the mediastinum through the abdomen and hiatus after extended proximal gastrectomy or total gastrectomy.


METHODS
From May 2010 to January 2012, 15 patients with esophagogastric junction carcinoma underwent open transhiatal extended gastrostomy or total gastrectomy. After full mobilization, the anvil was reversely introduced into the esophagus and the esophagus was transected with curved stapler. The rod of the anvil was then pulled out with a stitch to complete esophagogastrostomy after proximal gastrectomy(n=9) or esophagojejunostomy after total gastrectomy(n=6).


RESULTS
The anastomosis was successfully performed in all the patients. The mean operation time was(185.5±13.1) min. The mean operation time for anastomosis was(42.0±8.6) min. The mean estimated blood loss was (106.7±34.9) ml. The proximal resection margin was(4.4±1.2) cm. All the margins were negative for residual cancer. There was no postoperative death or fistula. During the follow up, there was one case of anastomotic stenosis which was successfully managed by endoscopic balloon dilatation.


CONCLUSIONS
Esophagogastrostomy or esophagojejunostomy can be safely performed with double stapling technique including reverse anvil introduction and curved stapling transection of the esophagus. It is an ideal technique for anastomosis after extended gastrectomy for esophagogastric junction carcinoma.
Department of Gastrointestinal and Colorectal Surgery, West China Hospital, Sichuan University, Chengdu, China. wangzqzyh@163.com
Zi-qiang
ZQ
Wang
Wen-jian
WJ
Meng
Xiang-bing
XB
Deng
Yuan-chuan
YC
Zhang
Ming-tian
MT
Wei
Ting-han
TH
Yang
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D004943:Esophagogastric Junction; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery