Comparison of single-stapling and hemi-double-stapling methods for intracorporeal esophagojejunostomy using a circular stapler after totally laparoscopic total gastrectomy.
Laparoscopic total gastrectomy is not widely performed because of the difficulty of esophagojejunal reconstruction. This study analyzed complication rates of two different methods for reconstruction by a circular stapler after totally laparoscopic total gastrectomy (TLTG).



Between 2010 and 2014, clinical data of 19 patients who underwent TLTG for gastric adenocarcinoma were collected retrospectively. There were two methods to fix the anvil of a circular stapler into the distal esophagus: In the single-stapling technique (SST) group, Endo-PSI(II) was used for purse-suturing on the distal esophagus for reconstruction, and in the hemi-double-stapling technique (hemi-DST) group, the esophagus was cut by linear stapler with the entry hole of the anvil shaft opened after inserting the anvil tail. In both groups, surgical procedures were the same, except for the reconstruction.



All TLTGs were performed securely without mortality. Intracorporeal laparoscopic esophagojejunal anastomosis was performed successfully for all the patients. In the hemi-DST group, four patients experienced anastomotic stenosis, three of whom required endoscopic balloon dilation. In contrast, no stenosis was seen in the SST group (p = 0.033).



Anastomosis with SST is preferred to that with hemi-DST to minimize postoperative complications.
Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, Japan. amisakim@gmail.com.
Masataka
M
Amisaki
Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, Japan.
Kyoichi
K
Kihara
Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, Japan.
Kanenori
K
Endo
Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, Japan.
Kazunori
K
Suzuki
Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, Japan.
Seiichi
S
Nakamura
Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, Japan.
Takashi
T
Sawata
Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, Japan.
Tetsu
T
Shimizu
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D004385:Duodenostomy / Q000379:methods; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome
Esophagojejunal anastomosis; Postoperative complication; Stenosis; Totally laparoscopic total gastrectomy