Skip to main content
Top
Published in: Surgical Endoscopy 7/2016

01-07-2016

Comparison of single-stapling and hemi-double-stapling methods for intracorporeal esophagojejunostomy using a circular stapler after totally laparoscopic total gastrectomy

Authors: Masataka Amisaki, Kyoichi Kihara, Kanenori Endo, Kazunori Suzuki, Seiichi Nakamura, Takashi Sawata, Tetsu Shimizu

Published in: Surgical Endoscopy | Issue 7/2016

Login to get access

Abstract

Background

Laparoscopic total gastrectomy is not widely performed because of the difficulty of esophagojejunal reconstruction. This study analyzed complication rates of two different methods for reconstruction by a circular stapler after totally laparoscopic total gastrectomy (TLTG).

Methods

Between 2010 and 2014, clinical data of 19 patients who underwent TLTG for gastric adenocarcinoma were collected retrospectively. There were two methods to fix the anvil of a circular stapler into the distal esophagus: In the single-stapling technique (SST) group, Endo-PSI(II) was used for purse-suturing on the distal esophagus for reconstruction, and in the hemi-double-stapling technique (hemi-DST) group, the esophagus was cut by linear stapler with the entry hole of the anvil shaft opened after inserting the anvil tail. In both groups, surgical procedures were the same, except for the reconstruction.

Results

All TLTGs were performed securely without mortality. Intracorporeal laparoscopic esophagojejunal anastomosis was performed successfully for all the patients. In the hemi-DST group, four patients experienced anastomotic stenosis, three of whom required endoscopic balloon dilation. In contrast, no stenosis was seen in the SST group (p = 0.033).

Conclusions

Anastomosis with SST is preferred to that with hemi-DST to minimize postoperative complications.
Appendix
Available only for authorised users
Literature
1.
go back to reference Shehzad K, Mohiuddin K, Nizami S, Sharma H, Khan IM, Memon B, Memon MA (2007) Current status of minimal access surgery for gastric cancer. Surg Oncol 16:85–98CrossRefPubMed Shehzad K, Mohiuddin K, Nizami S, Sharma H, Khan IM, Memon B, Memon MA (2007) Current status of minimal access surgery for gastric cancer. Surg Oncol 16:85–98CrossRefPubMed
2.
go back to reference Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72CrossRefPubMedPubMedCentral Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72CrossRefPubMedPubMedCentral
3.
go back to reference Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176CrossRefPubMed Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176CrossRefPubMed
4.
go back to reference Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237CrossRefPubMedPubMedCentral Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237CrossRefPubMedPubMedCentral
5.
go back to reference Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open versus laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–S311CrossRefPubMed Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open versus laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–S311CrossRefPubMed
6.
go back to reference Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open versus laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173CrossRefPubMed Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open versus laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173CrossRefPubMed
7.
go back to reference Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420CrossRefPubMed Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420CrossRefPubMed
8.
go back to reference Eom BW, Kim YW, Lee SE, Ryu KW, Lee JH, Yoon HM, Cho SJ, Kook MC, Kim SJ (2012) Survival and surgical outcomes after laparoscopy-assisted total gastrectomy for gastric cancer: case-control study. Surg Endosc 26:3273–3281CrossRefPubMed Eom BW, Kim YW, Lee SE, Ryu KW, Lee JH, Yoon HM, Cho SJ, Kook MC, Kim SJ (2012) Survival and surgical outcomes after laparoscopy-assisted total gastrectomy for gastric cancer: case-control study. Surg Endosc 26:3273–3281CrossRefPubMed
9.
go back to reference Kinoshita T, Oshiro T, Ito K, Shibasaki H, Okazumi S, Katoh R (2010) Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy. Surg Endosc 24:2908–2912CrossRefPubMed Kinoshita T, Oshiro T, Ito K, Shibasaki H, Okazumi S, Katoh R (2010) Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy. Surg Endosc 24:2908–2912CrossRefPubMed
10.
go back to reference Kim SG, Lee YJ, Ha WS, Jung EJ, Ju YT, Jeong CY, Hong SC, Choi SK, Park ST, Bae K (2008) LATG with extracorporeal esophagojejunostomy: is this minimal invasive surgery for gastric cancer? J Laparoendosc Adv Surg Tech A 18:572–578CrossRefPubMed Kim SG, Lee YJ, Ha WS, Jung EJ, Ju YT, Jeong CY, Hong SC, Choi SK, Park ST, Bae K (2008) LATG with extracorporeal esophagojejunostomy: is this minimal invasive surgery for gastric cancer? J Laparoendosc Adv Surg Tech A 18:572–578CrossRefPubMed
11.
go back to reference Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, Yu JS, Cho SJ, Lee JY, Kim CG, Choi IJ, Kook MC, Park SR, Kim MJ, Lee JS (2009) Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol 100:392–395CrossRefPubMed Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, Yu JS, Cho SJ, Lee JY, Kim CG, Choi IJ, Kook MC, Park SR, Kim MJ, Lee JS (2009) Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol 100:392–395CrossRefPubMed
12.
go back to reference Jeong GA, Cho GS, Kim HH, Lee HJ, Ryu SW, Song KY (2009) Laparoscopy-assisted total gastrectomy for gastric cancer: a multicenter retrospective analysis. Surgery 146:469–474CrossRefPubMed Jeong GA, Cho GS, Kim HH, Lee HJ, Ryu SW, Song KY (2009) Laparoscopy-assisted total gastrectomy for gastric cancer: a multicenter retrospective analysis. Surgery 146:469–474CrossRefPubMed
13.
go back to reference Shinohara T, Kanaya S, Taniguchi K, Fujita T, Yanaga K, Uyama I (2009) Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg 144:1138–1142CrossRefPubMed Shinohara T, Kanaya S, Taniguchi K, Fujita T, Yanaga K, Uyama I (2009) Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg 144:1138–1142CrossRefPubMed
14.
go back to reference Carboni F, Lepiane P, Santoro R, Mancini P, Lorusso R, Santoro E (2005) Laparoscopic surgery for gastric cancer: preliminary experience. Gastric Cancer 8:75–77CrossRefPubMed Carboni F, Lepiane P, Santoro R, Mancini P, Lorusso R, Santoro E (2005) Laparoscopic surgery for gastric cancer: preliminary experience. Gastric Cancer 8:75–77CrossRefPubMed
15.
go back to reference Nunobe S, Hiki N, Tanimura S, Kubota T, Kumagai K, Sano T, Yamaguchi T (2011) Three-step esophagojejunal anastomosis with atraumatic anvil insertion technique after laparoscopic total gastrectomy. J Gastrointest Surg 15:1520–1525CrossRefPubMed Nunobe S, Hiki N, Tanimura S, Kubota T, Kumagai K, Sano T, Yamaguchi T (2011) Three-step esophagojejunal anastomosis with atraumatic anvil insertion technique after laparoscopic total gastrectomy. J Gastrointest Surg 15:1520–1525CrossRefPubMed
16.
go back to reference Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc 23:2624–2630CrossRefPubMed Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc 23:2624–2630CrossRefPubMed
17.
go back to reference Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, Uyama I (2010) Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 211:e25–e29CrossRefPubMed Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, Uyama I (2010) Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 211:e25–e29CrossRefPubMed
18.
go back to reference Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A (1999) Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 2:230–234CrossRefPubMed Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A (1999) Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 2:230–234CrossRefPubMed
19.
go back to reference Strong VE (2015) Gastric cancer: Principles and practice. In: Badwell B, Mansfield PF (eds) Open methods of resection and reconstruction for subtotal and total gastrectomy. Springer International Publishing, Switzerland, pp 199–210 Strong VE (2015) Gastric cancer: Principles and practice. In: Badwell B, Mansfield PF (eds) Open methods of resection and reconstruction for subtotal and total gastrectomy. Springer International Publishing, Switzerland, pp 199–210
20.
go back to reference Strong VE (2015) Gastric cancer: Principles and practice. In: Yang HK, Park J (eds) Laparoscopic methods of resection and reconstruction for subtotal and total gastrectomy with D2 lymphadenectomy. Springer International Publishing, Switzerland, pp 211–228 Strong VE (2015) Gastric cancer: Principles and practice. In: Yang HK, Park J (eds) Laparoscopic methods of resection and reconstruction for subtotal and total gastrectomy with D2 lymphadenectomy. Springer International Publishing, Switzerland, pp 211–228
21.
go back to reference Dulucq JL, Wintringer P, Perissat J, Mahajna A (2005) Completely laparoscopic total and partial gastrectomy for benign and malignant diseases: a single institute’s prospective analysis. J Am Coll Surg 200:191–197CrossRefPubMed Dulucq JL, Wintringer P, Perissat J, Mahajna A (2005) Completely laparoscopic total and partial gastrectomy for benign and malignant diseases: a single institute’s prospective analysis. J Am Coll Surg 200:191–197CrossRefPubMed
22.
go back to reference Topal B, Leys E, Ectors N, Aerts R, Penninckx F (2008) Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc 22:980–984CrossRefPubMed Topal B, Leys E, Ectors N, Aerts R, Penninckx F (2008) Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc 22:980–984CrossRefPubMed
23.
go back to reference Mery CM, Shafi BM, Binyamin G, Morton JM, Gertner M (2008) Profiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure. Surg Obes Relat Dis 4:416–422CrossRefPubMed Mery CM, Shafi BM, Binyamin G, Morton JM, Gertner M (2008) Profiling surgical staplers: effect of staple height, buttress, and overlap on staple line failure. Surg Obes Relat Dis 4:416–422CrossRefPubMed
24.
go back to reference Zuiki T, Hosoya Y, Kaneda Y, Kurashina K, Saito S, Ui T, Haruta H, Hyodo M, Sata N, Lefor AT, Yasuda Y (2013) Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy. Surg Endosc 27:3683–3689CrossRefPubMed Zuiki T, Hosoya Y, Kaneda Y, Kurashina K, Saito S, Ui T, Haruta H, Hyodo M, Sata N, Lefor AT, Yasuda Y (2013) Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy. Surg Endosc 27:3683–3689CrossRefPubMed
25.
go back to reference Kong SH, Suh Y, Kwon S, Lee HJ, Kim HH, Yang HK (2013) Stable purse-string suturing using an anterior esophagotomy for reconstruction with a circular stapler during laparoscopic total gastrectomy. Asian J Endosc Surg 6:82–89CrossRefPubMed Kong SH, Suh Y, Kwon S, Lee HJ, Kim HH, Yang HK (2013) Stable purse-string suturing using an anterior esophagotomy for reconstruction with a circular stapler during laparoscopic total gastrectomy. Asian J Endosc Surg 6:82–89CrossRefPubMed
26.
go back to reference Omori T, Oyama T, Mizutani S, Tori M, Nakajima K, Akamatsu H, Nakahara M, Nishida T (2009) A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 197:e13–e17CrossRefPubMed Omori T, Oyama T, Mizutani S, Tori M, Nakajima K, Akamatsu H, Nakahara M, Nishida T (2009) A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 197:e13–e17CrossRefPubMed
27.
go back to reference Sakuramoto S, Kikuchi S, Futawatari N, Moriya H, Katada N, Yamashita K, Watanabe M (2010) Technique of esophagojejunostomy using transoral placement of the pretilted anvil head after laparoscopic gastrectomy for gastric cancer. Surgery 147:742–747CrossRefPubMed Sakuramoto S, Kikuchi S, Futawatari N, Moriya H, Katada N, Yamashita K, Watanabe M (2010) Technique of esophagojejunostomy using transoral placement of the pretilted anvil head after laparoscopic gastrectomy for gastric cancer. Surgery 147:742–747CrossRefPubMed
28.
go back to reference Kachikwu EL, Trisal V, Kim J, Pigazzi A, Ellenhorn JD (2011) Minimally invasive total gastrectomy for gastric cancer: a pilot series. J Gastrointest Surg 15:81–86CrossRefPubMed Kachikwu EL, Trisal V, Kim J, Pigazzi A, Ellenhorn JD (2011) Minimally invasive total gastrectomy for gastric cancer: a pilot series. J Gastrointest Surg 15:81–86CrossRefPubMed
29.
go back to reference Marangoni G, Villa F, Shamil E, Botha AJ (2012) OrVil™-assisted anastomosis in laparoscopic upper gastrointestinal surgery: friend of the laparoscopic surgeon. Surg Endosc 26:811–817CrossRefPubMed Marangoni G, Villa F, Shamil E, Botha AJ (2012) OrVil™-assisted anastomosis in laparoscopic upper gastrointestinal surgery: friend of the laparoscopic surgeon. Surg Endosc 26:811–817CrossRefPubMed
30.
go back to reference LaFemina J, Viñuela EF, Schattner MA, Gerdes H, Strong VE (2013) Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol 20:2975–2983CrossRefPubMed LaFemina J, Viñuela EF, Schattner MA, Gerdes H, Strong VE (2013) Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol 20:2975–2983CrossRefPubMed
31.
go back to reference Cianchi F, Macrì G, Indennitate G, Mallardi B, Trallori G, Biagini MR, Badii B, Staderini F, Perigli G (2014) Laparoscopic total gastrectomy using the transorally inserted anvil (OrVil™): a preliminary, single institution experience. Springerplus. doi:10.1186/2193-1801-3-434 PubMedPubMedCentral Cianchi F, Macrì G, Indennitate G, Mallardi B, Trallori G, Biagini MR, Badii B, Staderini F, Perigli G (2014) Laparoscopic total gastrectomy using the transorally inserted anvil (OrVil™): a preliminary, single institution experience. Springerplus. doi:10.​1186/​2193-1801-3-434 PubMedPubMedCentral
Metadata
Title
Comparison of single-stapling and hemi-double-stapling methods for intracorporeal esophagojejunostomy using a circular stapler after totally laparoscopic total gastrectomy
Authors
Masataka Amisaki
Kyoichi Kihara
Kanenori Endo
Kazunori Suzuki
Seiichi Nakamura
Takashi Sawata
Tetsu Shimizu
Publication date
01-07-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4588-9

Other articles of this Issue 7/2016

Surgical Endoscopy 7/2016 Go to the issue