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Surgical Endoscopy
Published in: Surgical Endoscopy 10/2013

01-10-2013

Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy

Authors: Toru Zuiki, Yoshinori Hosoya, Yuji Kaneda, Kentaro Kurashina, Shin Saito, Takashi Ui, Hidenori Haruta, Masanobu Hyodo, Naohiro Sata, Alan T. Lefor, Yoshikazu Yasuda

Published in: Surgical Endoscopy | Issue 10/2013

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Abstract

Background

The double-stapling technique (DST) for esophagojejunostomy using the transorally inserted anvil (OrVil; Covidien Japan, Tokyo, Japan) is one of the reconstruction methods used after laparoscopy-assisted total gastrectomy (LATG). This technique has potential advantages in terms of less invasive surgery without the need to create a complicated intraabdominal anastomosis.

Methods

From 2008 to 2011, 262 patients with gastric cancer underwent total gastrectomy and reconstruction with a Roux-en-Y anastomosis, and 52 patients underwent LATG with DST. A retrospective analysis then was performed comparing the patients who experienced postoperative stenosis after LATG-DST (positive group) and the patients who did not (negative group). A comparative analysis was performed among patients comparing conventional open total gastrectomy and LATG, and multivariate analysis was performed to evaluate risk factors for the development of anastomotic stenosis.

Results

A minor leak was found in 1 patient (1.9 %), and 11 patients experienced anastomotic stenosis (21 %) after LATG with DST. Among the patients with anastomotic stenosis, three (3/4, 75 %) anastomoses were performed with the 21-mm end-to-end anastomosis (EEA) stapler, and eight anastomoses were performed (8/47, 17 %) with the 25-mm EEA stapler. The median interval to the diagnosis of anastomotic stenosis was 43 days after surgery. The patients with stenosis needed endoscopic balloon dilation an average of four times, and the rate of perforation after dilation was 13 %. The clinical and operative characteristics did not differ between the two groups. Anastomotic stenosis after open total gastrectomy occurred in two cases (0.98 %). Multivariate analysis showed that the size of the EEA stapler and the use of DST were risk factors for anastomotic stenosis.

Conclusion

Esophagojejunostomy using DST with OrVil is useful in performing a minimally invasive procedure but carries a high risk of anastomotic stenosis.
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Metadata
Title
Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy
Authors
Toru Zuiki
Yoshinori Hosoya
Yuji Kaneda
Kentaro Kurashina
Shin Saito
Takashi Ui
Hidenori Haruta
Masanobu Hyodo
Naohiro Sata
Alan T. Lefor
Yoshikazu Yasuda
Publication date
01-10-2013
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 10/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-013-2945-0

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