Abstract
BackgroundRecently, due to increasing reports of stenosis after esophagojejunostomy created using circular staplers and a transorally inserted anvil (OrVil™) following laparoscopic proximal gastrectomy (LPG) and total gastrectomy (LTG), linear staplers are being used instead. We investigated our preventive procedure for esophagojejunostomy stenosis following use of circular staplers.MethodsSince the anastomotic stenosis is considered to be mainly caused by tension in the esophageal and jejunal stumps at the anastomotic site, we have been performing procedures to relieve this tension, by cutting off the rubber band and pushing the shaft of the circular stapler toward the esophageal side, since July 2015. We retrospectively compared the incidence of anastomotic stenosis in cases of LPG and LTG performed before July 2015 (early phase, 30 cases) versus those performed after this period (later phase, 22 cases).ResultsComparison of the incidence of anastomotic stenosis according to the type of surgery, LPG or LTG, and between the two time periods versus all cases, indicated a significantly lower incidence in the later phase than in the early phase (4.5 vs. 26.7%, p < 0.05), especially for LPG (0 vs. 38.5%, p < 0.05).ConclusionsIt is possible to use a circular stapler during laparoscopic esophagojejunostomy, as with open surgery, if steps to reduce tension on the anastomotic site are undertaken. These procedures will contribute to the spread of safe and simple laparoscopic anastomotic techniques.
Highlights
Due to increasing reports of stenosis after esophagojejunostomy created using circular staplers and a transorally inserted anvil (OrVilTM) following laparoscopic proximal gastrectomy (LPG) and total gastrec‐ tomy (LTG), linear staplers are being used instead
For early gastric cancer limited to the upper third of the stomach, we typically perform laparoscopic proximal gastrectomy (LPG), with reconstruction by the double tract (DT) method or jejunal interposition (JIP) method [5]
For extensive early gastric cancer not localized to the upper third of the stomach or multiple early gastric cancers, laparoscopic total gastrectomy (LTG) with Roux en Y reconstruction is performed [6]
Summary
Due to increasing reports of stenosis after esophagojejunostomy created using circular staplers and a transorally inserted anvil (OrVilTM) following laparoscopic proximal gastrectomy (LPG) and total gastrec‐ tomy (LTG), linear staplers are being used instead. For extensive early gastric cancer not localized to the upper third of the stomach or multiple early gastric cancers, laparoscopic total gastrectomy (LTG) with Roux en Y reconstruction is performed [6] Both of these surgical procedures involve the important step of esophagojejunostomy, which has the potential to cause problems related to the anastomotic site, which have a great impact on postoperative quality of life (QOL) since they can delay oral intake and prolong the duration of hospital stay [7]. We perform esophagojejunostomy using a circular stapler (CS) and a transorally inserted anvil (OrVilTM, Covidien, Mansfield, MA, USA), many surgeons use a linear stapler and perform reconstruction using functional end to end anastomosis [8, 9] or an overlap method [10, 11] because of the high incidence of occurrence of anastomotic stenosis with laparoscopic surgery [12,13,14]. We aimed to resolve the uncertainties related to laparoscopic use of a CS
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