Does the Single-Stapling Technique for Circular-Stapled Esophagojejunostomy Reduce Anastomotic Complications After Laparoscopic Total Gastrectomy?

Abstract

Laparoscopic total gastrectomy (LTG) is used for early gastric cancer (EGC) in the upper stomach. However, the incidences of postoperative anastomotic complications such as leakage and stricture remain high. This study investigated whether using a single-stapling technique (SST) instead of a hemi-double-stapling technique (HDST) for intracorporeal circular-stapled esophagojejunostomy could reduce anastomotic complications after LTG. This retrospective study included 136 patients with EGC treated by LTG with intracorporeal circular-stapled esophagojejunostomy. Originally, HDST was used for esophagojejunostomy in 71 patients (original group). Thereafter, the esophagojejunostomy procedure was modified, and SST was used in a further 65 patients (modified group). The impact of the anastomotic procedure (SST or HDST) on anastomotic complications after LTG was determined by uni- and multivariate analyses. The incidence of anastomotic complications was significantly lower in the modified group (7.7 %) than in the original group (22.5 %; P = 0.017). The frequency of anastomotic leakage was lower in the modified group (3.1 %) than in the original group (9.9 %), although the difference was not statistically significant. Meanwhile, the frequency of anastomotic stricture was significantly less common in the modified group (6.2 %) than in the original group (18.3 %; P = 0.032). Multivariate analysis showed that anastomotic procedure with SST was significantly associated with a lower rate of postoperative anastomotic complications (odds ratio [OR], 0.217; 95 % confidence interval [CI], 0.063-0.631; P = 0.004), as was the operation time (OR, 0.237; 95 % CI 0.082-0.667; P = 0.007). The use of SST for intracorporeal circular-stapled esophagojejunostomy could reduce anastomotic complications after LTG.