title: Stable purse-string suturing using an anterior esophagotomy for reconstruction with a circular stapler during laparoscopic total gastrectomy.
abstract: BACKGROUND
  During a laparoscopic total gastrectomy, the combined process of purse-string suture placement and anvil insertion of a circular stapler is one of the most difficult steps in the reconstruction. We have developed a stable and reliable technique in which purse-string suture placement and anvil insertion using anterior esophagotomy precede complete transection of the esophagus.
  
  
  METHODS
  The procedure involves tying the distal esophagus, insufflating the esophagus via a nasogastric tube, anterior wall purse-string suture, anterior esophagotomy, posterior wall purse-string suture, anvil insertion, fastening purse-string suture, and transecting the esophagus. The technique has been employed in nine patients since April 2011.
  
  
  RESULTS
  Eight of the nine gastrectomies were for patients with stage IA early gastric cancer and one was for a patient with medically intractable bleeding from multiple polyps. Three were men and six were women. Average BMI was 25.2 ± 5.3 (range, 16.3-33.9). Mean operation time was 276.2 ± 56.3 min (range, 215.0-395.0 min) and the mean duration for anvil insertion was 29.8 ± 7.0 min (range, 23.0-46.0 min). There were no intraoperative or postoperative anastomosis-related complications or mortality.
  
  
  CONCLUSIONS
  Our method of anvil insertion of a circular stapler can be a good option for safe and reliable esophagojejunostomy during a laparoscopic total gastrectomy.
authors: Department of Surgery, Seoul National University Hospital, Seoul, Korea.
authors: Seong-Ho
authors: SH
authors: Kong
authors: Yunsuhk
authors: Y
authors: Suh
authors: Sebastianus
authors: S
authors: Kwon
authors: Hyuk-Joon
authors: HJ
authors: Lee
authors: Hyung-Ho
authors: HH
authors: Kim
authors: Han-Kwang
authors: HK
authors: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome