Evaluation of intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy using linear stapler

Abstract

Backgrounds and Aims: We previously reported our procedure using linear staplers for intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy (LTG) that did not require hand sewing. To evaluate safety of our anastomotic procedure, we analyzed the incidence of intra- and post-operative complications using our prospectively maintained database. Methods: From September 2006 to December 2009, 51 patients with gastric cancer underwent LTG at our hospital. Laparoscopic esophagojejunal anastomoses using linear staplers were performed for all 51 patients. In brief, the esophagus was transected by an endoscopic linear stapler (ETS-Flex 45, Ethicon Endosurgery), while being rotated by about 45 degrees counterclockwise to facilitate the following anastomosis more effectively. After whole stomach was exteriorized and Y-anastomosis was completed, an endoscopic linear stapler was applied to create a side-to-side anastomosis between the left dorsal side of the esophagus and the jejunal limb intracorporeally. When applying the linear stapler, firstly the anvil side was inserted into the small hole of the jejunal limb, then the cartridge side was applied to the small hole of the esophageal cut end, being guided by naso-gastric tube. The entry hole was first closed roughly with hernia staplers (Endo Universal 65 staplers) to facilitate the following procedures more easily and sufficiently. Subsequently, an endoscopic linear stapler was applied so that all hernia staplers could be removed. Results: Laparoscopic esophagojejunal anastomosis was successfully performed for 50 patients (98.0%). Intracorporeal anastomosis failed in one patient (2.0%) because a naso-gastric tube was caught between the jaws of an endostapler, which resulted in a conversion to open procedure. No postoperative anastomotic complications, such as anastomotic leakage or stenosis, occurred. There was no mortality. Conclusions: The current study suggested that our procedure of intracorporeal linearstapled esophagojejunal anastomosis could be carried out safely. This technique could become one of the standard methods for reconstruction after LTG.