A Novel Technique of Hand-Sewn Purse-String Suturing by Double Ligation Method (DLM) for Intracorporeal Circular Esophagojejunostomy
- Author:
Yuichi TAKAYAMA
1
;
Yuji KANEOKA
;
Atsuyuki MAEDA
;
Yasuyuki FUKAMI
;
Takamasa TAKAHASHI
;
Masahito UJI
Author Information
- Publication Type:Original Article
- Keywords: Laparoscopy; Gastrectomy; Anastomosis; Postoperative complications
- MeSH: Anastomotic Leak; Classification; Constriction, Pathologic; Dilatation; Esophagus; Gastrectomy; Head; Humans; Incidence; Laparoscopy; Ligation; Methods; Mortality; Postoperative Complications; Retrospective Studies; Sutures
- From:Journal of Gastric Cancer 2019;19(3):290-300
- CountryRepublic of Korea
- Language:English
- Abstract: 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 ≥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.
