title: A Simple and Reliable Method for Intracorporeal Circular-Stapled Esophagojejunostomy Using a Hand-Sewn Over-and-Over Suture Technique in Laparoscopic Total Gastrectomy.
abstract: BACKGROUND
  The controversy regarding laparoscopic total gastrectomy (LTG) is mainly due to the difficulty associated with esophagojejunostomy during this procedure. Although several techniques have so far been reported to overcome this issue,1 (-) 4 a reliable technique has not yet been established. We developed intracorporeal esophagojejunostomy using a circular stapler in LTG with a hand-sewn over-and-over suture technique, and have shown its favorable outcomes compared with those of conventional open surgery.5 This technique is presented in the video.
  
  
  METHODS
  After transection of the esophagus, an over-and-over suture with a 2-0 monofilament is placed counterclockwise from the right to the left side of the cut end in an outside-to-inside direction, and then from the left to the right side in an inside-to-outside direction. After insertion of the anvil head into the esophagus, it was fixed by ligation of the thread. Finally, intracorporeal esophagojejunal anastomosis was performed using a circular stapler.
  
  
  RESULTS
  In LTG, reconstruction using this method was performed for 23 consecutive patients with gastric cancer. There were no serious intraoperative complications or need for conversion to open surgery. Anastomotic leakage and stenosis occurred in one case each, respectively. The mean time for fixation of the anvil to the esophagus was 15 min for the last 12 consecutive patients.
  
  
  CONCLUSIONS
  This method is simple and feasible, and the advantage of this technique is the elimination of the backhand stroke throughout the suturing procedure.
authors.affiliation: Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan. takerumatsuda@nifty.com.
authors.forename: Takeru
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwasaki
authors.affiliation: Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Mitsutsuji
authors.affiliation: Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
authors.forename: Kenro
authors.initials: K
authors.lastname: Hirata
authors.affiliation: Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tsugawa
authors.affiliation: Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sugita
authors.affiliation: Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
authors.forename: Etsuji
authors.initials: E
authors.lastname: Shimada
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak; D004947:Esophagus / Q000601:surgery*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*; D013536:Suture Techniques