title: Safety of transorally-inserted anvil for esophagojejunostomy in laparoscopic total gastrectomy.
abstract: BACKGROUND
  To assess the safety of transorally-inserted anvil (TOA) for use during esophagojejunostomy (EJ) reconstruction during laparoscopic total gastrectomy (LTG).
  
  
  METHODS
  Between March 2009 and December 2011, 39 consecutive open total gastrectomies (OTGs) and 36 LTGs using TOA for gastric cancer were comparatively evaluated. We investigated postoperative complications, using the Clavien-Dindo classification. To evaluate the effect of a learning period in using TOA for LTG, we also investigated shifts in the patterns of complications and changes in total operation time over the course of the study.
  
  
  RESULTS
  The patient characteristics at baseline were not different between both groups, except for the extent of lymphadenectomy (P < 0.001) and depth of tumor invasion (P = 0.003). Multivariate analysis revealed that TOA usage elevated the occurrence of infectious complications significantly (OR = 3.32, P = 0.042), but was not associated with EJ-related complications. TOA usage did not need a learning period for the length of time required to complete the operation, or the likelihood of developing an EJ-related or infectious complication.
  
  
  CONCLUSIONS
  TOA use for EJ during LTG is relatively simple and easy enough not to require a learning period for surgeons. This procedure did not elevated the occurrence of EJ-related complications compared to circular stapling in open surgery, but it does require special prevention efforts to avoid infectious complications.
authors.affiliation: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, Republic of Korea. Electronic address: kukwon@korea.ac.kr.
authors.forename: Y
authors.initials: Y
authors.lastname: Kwon
authors.affiliation: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, Republic of Korea. Electronic address: sungilmd@gmail.com.
authors.forename: S I
authors.initials: SI
authors.lastname: Cho
authors.affiliation: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, Republic of Korea. Electronic address: xxmazinga@hotmail.com.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Kwon
authors.affiliation: Department of Biostatistics, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, Republic of Korea.
authors.forename: K S
authors.initials: KS
authors.lastname: Yang
authors.affiliation: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, Republic of Korea. Electronic address: jyjclick@korea.ac.kr.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Jang
authors.affiliation: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, Republic of Korea. Electronic address: ppongttai@medimail.co.kr.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, Republic of Korea. Electronic address: pshchw@korea.ac.kr.
authors.forename: S H
authors.initials: SH
authors.lastname: Park
authors.affiliation: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, Republic of Korea. Electronic address: yjmok@korea.ac.kr.
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Mok
authors.affiliation: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, Republic of Korea. Electronic address: kugspss@korea.ac.kr.
authors.forename: S
authors.initials: S
authors.lastname: Park
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D015331:Cohort Studies; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D007582:Jejunostomy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation* / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D061646:Operative Time; D061214:Patient Safety; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods; D016896:Treatment Outcome
keywords: Gastrectomy; Laparoscopy; Surgical anastomosis