307. INGENUITY OF ESOPHAGOGASTRIC ANASTOMOSIS IN OUR DEPARTMENT -RECONSTRUCTED GASTRIC TUBE STUMP CLOSURE USING ENDO GIA RADIAL RELOAD

Abstract

Abstract Anastomotic leakage is one of the three major complications after esophagectomy and can lead to surgery-related death. In our department, the standard surgical procedure is to elevate the gastric conduit via the posterior mediastinal pathway, and end-to-side anastomosis using a circular stapler for the residual esophagus and gastric conduit. In this study, we will report our reconstruction method and ingenuity, since Linear stapler was changed to Endo GIA Radial Reload and better outcomes were delivered. The lesser curvature of the gastric conduit stump is the site where blood flow is most reduced. When the gastric conduit stump is closed with Linear stapler, the blood flow may be further reduced, because the stapler on the lesser curvature of the gastric conduit and the stapler on gastric conduit stump intersect. Closing the gastric conduit stump using Radial Reload avoids the stapler intersect at the lesser curvature and the gastric conduit stump. In addition, since a natural curve is formed at the gastric conduit stump, the pressure applied to the gastric tube stump by coughing can be dispersed. Nine patients have undergone this reconstruction method, and no anastomotic leakage has been observed. It is important to constantly evaluate one’s own surgical technique, and to continue developing the surgical technique for further safety by making improvements.