Top

Published in:

01-05-2019

The crossover technique for intracorporeal esophagojejunostomy following laparoscopic total gastrectomy: a simple and safe technique using a linear stapler and two barbed sutures

Authors: Sang-Woong Lee, Masaru Kawai, Keitaro Tashiro, Satoshi Kawashima, Ryo Tanaka, Keitaro Tanaka, Eiji Nomura, Kazuhisa Uchiyama

Published in: Surgical Endoscopy | Issue 5/2019

Abstract

Background

Totally laparoscopic gastrectomy (LG) is preferred over open gastrectomy because it allows safe anastomosis, a small wound, and early bowel recovery. However, esophagojejunostomy (EJS) following laparoscopic total gastrectomy (LTG) remains technically challenging. To popularize LTG, a secure method of reconstruction must be developed. We present a simple and safe technique for intracorporeal EJS following LTG.

Methods

Our modified technique for intracorporeal EJS as a part of Roux-en-Y reconstruction following LTG incorporates an isoperistaltic stapled EJS with closure of the entry hole using two unidirectional barbed sutures. First, a side-to-side isoperistaltic EJS is created between the dorsal and left side of the esophagus and the jejunal arm. Second, the opening for the stapler is closed with a two-layer continuous suture using two 15-cm 3-0 V-Loc suture devices. The full-thickness inner layer closure commences from the sides of the staple lines and progresses toward the center of the enterotomy. During suturing, the remaining thread is utilized to apply tension and lift the enterotomy. Once the full-thickness layer closure is complete at the center of the enterotomy, suturing of the second seromuscular layer is started in the forward direction toward each corner to give a crossover-shaped suturing line.

Results

From February 2012 to October 2017, 27 patients with gastric cancer underwent LTG with intracorporeal stapled EJS as a part of Roux-en-Y reconstruction. All procedures were successfully performed without any intra- or postoperative anastomosis-related complications. No conversion to other procedures was required. The mean suturing time was 19.1 ± 9.5 min. The mean postoperative time to tolerating a liquid diet was 3.3 days, and the mean hospital stay was 12.1 days.

Conclusions

We herein report our procedure for intracorporeal EJS using a linear stapler and barbed sutures. This technique is simple and feasible and has acceptable morbidity.

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386. https://doi.org/10.1002/ijc.29210 CrossRefPubMed

Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K (2004) Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol: Off J Am Soc Clin Oncol 22(14):2767–2773. https://doi.org/10.1200/JCO.2004.10.184 CrossRef

Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11(5):439–449. https://doi.org/10.1016/S1470-2045(10)70070-X CrossRefPubMed

Song KY, Park CH, Kang HC, Kim JJ, Park SM, Jun KH, Chin HM, Hur H (2008) Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study. J Gastrointest Surg 12(6):1015–1021. https://doi.org/10.1007/s11605-008-0484-0 CrossRefPubMed

Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, Park SM (2008) Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 22(2):436–442. https://doi.org/10.1007/s00464-007-9446-y CrossRefPubMed

Ikeda O, Sakaguchi Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, Ohga T, Adachi E, Toh Y, Okamura T, Baba H (2009) Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc 23(10):2374–2379. https://doi.org/10.1007/s00464-009-0360-3 CrossRefPubMed

Lee SW, Bouras G, Nomura E, Yoshinaka R, Tokuhara T, Nitta T, Tsunemi S, Tanigawa N (2010) Intracorporeal stapled anastomosis following laparoscopic segmental gastrectomy for gastric cancer: technical report and surgical outcomes. Surg Endosc 24(7):1774–1780. https://doi.org/10.1007/s00464-009-0803-x CrossRefPubMed

Lee SW, Tanigawa N, Nomura E, Tokuhara T, Kawai M, Yokoyama K, Hiramatsu M, Okuda J, Uchiyama K (2012) Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy. World J Surg Oncol 10:267. https://doi.org/10.1186/1477-7819-10-267 CrossRefPubMedPubMedCentral

Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y (2013) Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg. https://doi.org/10.1097/SLA.0b013e31828dfa5d CrossRef

10.

Lee SW, Nomura E, Tokuhara T, Kawai M, Matsuhashi N, Yokoyama K, Fujioka H, Hiramatsu M, Okuda J, Uchiyama K (2011) Laparoscopic technique and initial experience with knotless, unidirectional barbed suture closure for staple-conserving, delta-shaped gastroduodenostomy after distal gastrectomy. J Am Coll Surg 213(6):e39–e45. https://doi.org/10.1016/j.jamcollsurg.2011.09.004 CrossRefPubMed

11.

Facy O, De Blasi V, Goergen M, Arru L, De Magistris L, Azagra JS (2013) Laparoscopic gastrointestinal anastomoses using knotless barbed sutures are safe and reproducible: a single-center experience with 201 patients. Surg Endosc 27(10):3841–3845. https://doi.org/10.1007/s00464-013-2992-6 CrossRefPubMed

12.

Lee SW, Kawai M, Tashiro K, Nomura E, Tokuhara T, Kawashima S, Tanaka R, Uchiyama K (2016) Laparoscopic gastrointestinal anastomoses using knotless barbed absorbable sutures are safe and reproducible: a single-center experience with 242 patients. Japanese J Clin Oncol. https://doi.org/10.1093/jjco/hyv212 CrossRefPubMed

13.

Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14(2):101–112. https://doi.org/10.1007/s10120-011-0041-5 CrossRef

14.

Association JGC (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123CrossRef

15.

Sano T, Sasako M, Mizusawa J, Yamamoto S, Katai H, Yoshikawa T, Nashimoto A, Ito S, Kaji M, Imamura H, Fukushima N, Fujitani K (2016) Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma. Ann Surg. https://doi.org/10.1097/SLA.0000000000001814 CrossRef

16.

Lee SW, Shinohara H, Matsuki M, Okuda J, Nomura E, Mabuchi H, Nishiguchi K, Takaori K, Narabayashi I, Tanigawa N (2003) Preoperative simulation of vascular anatomy by three-dimensional computed tomography imaging in laparoscopic gastric cancer surgery. J Am Coll Surg 197(6):927–936. https://doi.org/10.1016/j.jamcollsurg.2003.07.021 CrossRefPubMed

17.

Lee SW, Nomura E, Bouras G, Tokuhara T, Tsunemi S, Tanigawa N (2010) Long-term oncologic outcomes from laparoscopic gastrectomy for gastric cancer: a single-center experience of 601 consecutive resections. J Am Coll Surg 211(1):33–40. https://doi.org/10.1016/j.jamcollsurg.2010.03.018 CrossRefPubMed

18.

Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, Yoshida K, Takagane A, Kojima K, Sakuramoto S, Shiraishi N, Kitano S (2015) A multi-institutional, prospective, phase ii feasibility study of laparoscopy-assisted distal gastrectomy with d2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39(11):2734–2741. https://doi.org/10.1007/s00268-015-3160-z CrossRefPubMed

19.

Nashimoto A, Akazawa K, Isobe Y, Miyashiro I, Katai H, Kodera Y, Tsujitani S, Seto Y, Furukawa H, Oda I, Ono H, Tanabe S, Kaminishi M (2013) Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer 16(1):1–27. https://doi.org/10.1007/s10120-012-0163-4 CrossRef

20.

Siewert JR, Sendler A (1999) The current management of gastric cancer. Adv Surg 33:69–93PubMed

21.

Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195(2):284–287CrossRefPubMed

22.

Takaori K, Nomura E, Mabuchi H, Lee SW, Agui T, Miyamoto Y, Iwamoto M, Watanabe H, Tanigawa N (2005) A secure technique of intracorporeal Roux-Y reconstruction after laparoscopic distal gastrectomy. Am J Surg 189(2):178–183. https://doi.org/10.1016/j.amjsurg.2004.09.008 CrossRefPubMed

23.

Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13(4):238–244. https://doi.org/10.1007/s10120-010-0565-0 CrossRefPubMed

24.

Degiuli M, Sasako M, Ponti A (2010) Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 97(5):643–649. https://doi.org/10.1002/bjs.6936 CrossRefPubMed

25.

Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol: Off J Am Soc Clin Oncol 32(7):627–633. https://doi.org/10.1200/JCO.2013.48.8551 CrossRef

26.

Tanigawa N, Lee S-W, Bouras G (2015) Laparoscopy-assisted total gastrectomy. In: Hochwald S, Kukar M (eds) Minimally invasive foregut surgery for malignancy. Springer, Cham, pp 243–260

27.

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(4):230–234CrossRefPubMed

28.

Tanimura S, Higashino M, Fukunaga Y, Kishida S, Ogata A, Fujiwara Y, Osugi H (2007) Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Br J Surg 94(2):204–207. https://doi.org/10.1002/bjs.5542 CrossRefPubMed

29.

Okabe H, Obama K, Tanaka E, Nomura A, Kawamura J, Nagayama S, Itami A, Watanabe G, Kanaya S, Sakai Y (2009) Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc 23(9):2167–2171. https://doi.org/10.1007/s00464-008-9987-8 CrossRefPubMed

30.

Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Lirici MM, Napolitano C, Piro F (2004) Videolaparoscopic total and subtotal gastrectomy with extended lymph node dissection for gastric cancer. Am J Surg 188(6):728–735CrossRefPubMed

Title: The crossover technique for intracorporeal esophagojejunostomy following laparoscopic total gastrectomy: a simple and safe technique using a linear stapler and two barbed sutures
Authors: Sang-Woong Lee
Masaru Kawai
Keitaro Tashiro
Satoshi Kawashima
Ryo Tanaka
Keitaro Tanaka
Eiji Nomura
Kazuhisa Uchiyama
Publication date: 01-05-2019
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6413-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The crossover technique for intracorporeal esophagojejunostomy following laparoscopic total gastrectomy: a simple and safe technique using a linear stapler and two barbed sutures

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2019

Quantitative analysis of colon perfusion pattern using indocyanine green (ICG) angiography in laparoscopic colorectal surgery

High cardiovascular risk patients benefit more from bariatric surgery than low cardiovascular risk patients

Transcervical minimally invasive esophagectomy using da Vinci® SP™ Surgical System: a feasibility study in cadaveric model

Novel real-time optical imaging modalities for the detection of neoplastic lesions in urology: a systematic review

A comparison between one- and two-stage revisional gastric bypass

Comparison of postoperative pain at umbilical wound after conventional laparoscopic cholecystectomy between transumbilical and infraumbilical incisions: a randomized control trial