Introduction The development of laparoscopic gastrectomy has lead to the need for intracorporeal stapled oesophagojejunostomy. Described techniques include overlap with a linear stapler1 and oral insertion of the anvil of a circular stapler.2 At our unit, we use a novel technique for laparoscopic oesophagojejunostomy by laparoscopic insertion of anvil into the gastrointestinal tract. Here we present our outcomes from laparoscopic oesophagojejunostomy performed by the anvil suture pull-through technique.
Methods After attaching a suture to the end of the spike of the anvil of a circular stapler, the anvil is inserted into the gastrointestinal tract through a proximal gastrotomy and pushed into the distal oesophagus. The oesophagus is divided below the anvil with a linear stapler. The suture poking out of the staple line is pulled and a small incision is made to allow the spike of the anvil to be delivered. The body of the circular stapler is inserted into the jejunum and combined with the anvil before firing the stapler and completing the double-stapled anastomosis. Intracorporeal oesophagojejunostomy using this technique was performed during laparoscopic proximal and total gastrectomy between 1998 and 2011.
Results A total of 82 anastomoses were performed using the anvil suture pull-through technique as part of 35 total and 47 proximal gastric resections for gastric cancer. 69 patients (84%) had early gastric cancer. Anastomotic leakage occurred in three patients (3.7%) and stenosis occurred in seven patients (8.5%). Post-operative stasis occurred in one patient (1.2%). No anastomotic bleeding was encountered. Recurrence at the site of the anastomosis was not detected during routine follow-up endoscopy in any of the patients.
Conclusion Intracorporeal oesophagojejunostomy using our anvil suture pull-through technique is feasible, safe and associated with good outcomes in the context of early gastric cancer. It is a reliable first-line technique and a useful alternative strategy when overlap is not possible or oral anvil insertion is contraindicated.
Competing interests None declared.
References 1. Okabe H, Obama K, Tanaka E, et al. Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc 2009;23:2167–71.
2. Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc 2009;23:2624–30.