title: Creation of the ideal gastric tube: Comparison of three methods: A prospective cohort study.
abstract: BACKGROUND
  Various types of staplers are used for gastric tube formation after esophagectomy. Using a stapling device, a gastric tube can safely be created in a short amount of time. The problems with gastric tube creation using only linear type staplers include staple overlap as well as the problem of cost associated with using multiple staplers. To address this, both linear and radial type staplers have been introduced. We herein compare three methods of gastric tube creation.
  
  
  METHODS
  From 2012 to 2014, 62 patients with esophageal cancer underwent esophagectomy with gastric tube reconstruction. We evaluated and compared the mean number of stapler loads and cost in each groups.
  
  
  RESULTS
  The mean number of stapler loads was 6.24 in method A, 5.16 in method B, and 4.33 in method C. The mean cost accounting for total staple fires per case was 3116.07 dollars in the method A group, 2576.74 dollars in the method B group, and 2447.78 dollars in the method C group. Anastomotic leaks developed in 4 cases in the method A group and in 3 cases in the method B group. There were no anastomotic leaks in the method C group.
  
  
  CONCLUSIONS
  We hypothesize that by using radial type staplers, we can create a durable gastric tube and reduce the number of staplers and therefore reduce operative cost.
authors.affiliation: Department of Surgery, Nagoya City East Medical Center, 2-23 Wakamizu 1, Chikusa-ku, Nagoya 464-1308, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kimura
authors.affiliation: Department of Surgery, Nagoya City West Medical Center, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Mitsui
authors.affiliation: Department of Surgery, Nagoya City West Medical Center, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kuwabara
keywords: Gastric tube; Surgical stapler