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Takayama, Yuichi,Kaneoka, Yuji,Maeda, Atsuyuki,Fukami, Yasuyuki,Takahashi, Takamasa,Uji, Masahito The Korean Gastric Cancer Association 2019 Journal of gastric cancer Vol.19 No.3
Purpose: The optimal method for intracorporeal esophagojejunostomy remains unclear because a purse-string suture for fixing the anvil into the esophagus is difficult to perform with a laparoscopic approach. Therefore, this study aimed to evaluate our novel technique to fix the anvil into the esophagus. Materials and Methods: This retrospective study included 202 patients who were treated at our institution with an intracorporeal circular esophagojejunostomy in a laparoscopy-assisted total gastrectomy with a Roux-en-Y reconstruction (166 cases) or a laparoscopy-assisted proximal gastrectomy with jejunal interposition (36 cases). After incising 3/4 of the esophageal wall, a hand-sewn purse-string suture was placed on the esophagus. Next, the anvil head of a circular stapler was introduced into the esophagus. Finally, the circular esophagojejunostomy was performed laparoscopically. The clinical characteristics and surgical outcomes were evaluated and compared with those of other methods. Results: The average operation time was 200.3 minutes. The average hand-sewn purse-string suturing time was 6.4 minutes. The overall incidence of postoperative complications (Clavien-Dindo classification grade ${\geq}II$) was 26%. The number of patients with an anastomotic leakage and stenosis at the esophagojejunostomy site were 4 (2.0%) and 12 (6.0%), respectively. All patients with stenosis were successfully treated by endoscopic balloon dilatation. There was no mortality. Regarding the materials and devices for anvil fixation, only 1 absorbable thread was needed. Conclusions: Our procedure for hand-sewn purse-string suturing with the double ligation method is simple and safe.
Yuichi Takayama,Yuji Kaneoka,Atsuyuki Maeda,Yasuyuki Fukami,Takamasa Takahashi,Masahito Uji 대한위암학회 2019 Journal of gastric cancer Vol.19 No.3
Purpose: The optimal method for intracorporeal esophagojejunostomy remains unclearbecause a purse-string suture for fixing the anvil into the esophagus is difficult to performwith a laparoscopic approach. Therefore, this study aimed to evaluate our novel technique tofix the anvil into the esophagus. Materials and Methods: This retrospective study included 202 patients who were treatedat our institution with an intracorporeal circular esophagojejunostomy in a laparoscopyassistedtotal gastrectomy with a Roux-en-Y reconstruction (166 cases) or a laparoscopyassistedproximal gastrectomy with jejunal interposition (36 cases). After incising 3/4 ofthe esophageal wall, a hand-sewn purse-string suture was placed on the esophagus. Next,the anvil head of a circular stapler was introduced into the esophagus. Finally, the circularesophagojejunostomy was performed laparoscopically. The clinical characteristics andsurgical outcomes were evaluated and compared with those of other methods. Results: The average operation time was 200.3 minutes. The average hand-sewn pursestringsuturing time was 6.4 minutes. The overall incidence of postoperative complications(Clavien–Dindo classification grade ≥II) was 26%. The number of patients with ananastomotic leakage and stenosis at the esophagojejunostomy site were 4 (2.0%) and 12(6.0%), respectively. All patients with stenosis were successfully treated by endoscopicballoon dilatation. There was no mortality. Regarding the materials and devices for anvilfixation, only 1 absorbable thread was needed. Conclusions: Our procedure for hand-sewn purse-string suturing with the double ligationmethod is simple and safe.
Takamasa Takahashi,Yuji Kaneoka,Atsuyuki Maeda,Yuichi Takayama,Hiroki Aoyama,Takahiro Hosoi,Kazuaki Seita 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.2
Purpose: In minimally invasive esophagectomy (MIE), it is important to reduce the rate of anastomotic leakage to ensure its safety. At our institute, the double-ligation method (DLM) has been introduced to insert and fix the anvil of the circular stapler for intracorporeal circular esophagojejunostomy in gastric surgery. We adopted this method for intrathoracic anastomosis (IA) in MIE. The aim of this study was to investigate the safety of IA with DLM in MIE. Methods: In this study, 48 patients diagnosed with primary middle or lower third segment thoracic esophageal carcinoma with clinical stage I, II, III or IV disease were retrospectively evaluated. Postoperative outcomes were assessed. Results: Among the 48 patients, 42 patients underwent laparo-thoracoscopic esophagectomy and IA using a circular stapler with the DLM. The average total operation time and thoracoscopic operation time were 433 and 229 minutes, respectively. The average pursestring suturing time was 4.7 minutes. The rates of anastomotic leakage and stenosis were 2.4% and 14.3%, respectively. The overall incidence of postoperative complications (Clavien- Dindo grade of ≥III) was 16.7%. The average postoperative stay was 16 days. Conclusion: The procedure of IA using a circular stapler with the DLM in MIE was safe and provided a low rate of anastomotic leakage.