A method for shaping a smooth gastric tube

Abstract

The quality of the gastric tube commonly used for reconstruction after esophagectomy can influence postoperative progress. Moreover, formation of a gastric tube cannot generally be re-performed. To create a smooth gastric tube, various devices and two or more staplers are used; the use of two or more staplers means that an intersection exists. The intersection is inherently weak, and needs reinforcement as a potential site of leakage. To verify the optimal orientation relative to the previous stapler, we experimented using the stomach of a pig. Difficulty was encountered inserting the stapler when orientation relative to the previous stapler was changed. The shape of the gastric wall and the staples after firing were observed. The intersection of the first and second staplers is complicated as the angle increases and the modification required to the stomach also increases. In the part that is not an intersection, almost all of the staples had a perfect form. At 0°, half of the staples had perfect forms, but the remaining half of the staples were distorted in shape. At 90°, none of the staples had perfect shape. Insertion of the stapler was easy and little modification of the stomach wall was needed with the radial stapler. Herein we describe some to note at the time of gastric tube creation and our technique for the formation of a well-shaped gastric tube in which the unstapled intersection seems to maintain a natural curve and is not prone to leakage. The use of a radial stapler, in addition to a linear stapler, is a very useful and safe method for the formation of the gastric tube.