Application value of overlap guiding tube (OGT) in assisting overlap esophagojejunostomy during laparoscopic total gastrectomy for gastric/gastroesophageal junction (G/GEJ) tumors

Abstract

Background The overlap guiding tube (OGT) method, which was designed by our team to assist in overlap esophagojejunostomy, could potentially provide new perspectives for esophagojejunostomy. The application of the OGT-assisted method was first explored by our team and has not yet been reported. Methods This cohort study analyzed the 3 month outcomes of 38 gastric/gastroesophageal junction (G/GEJ) tumor patients who underwent OGT-assisted overlap esophagojejunostomy. Results There were 27 males and 11 females, aged 40–82 years. All patients underwent surgery successfully. The success rate of inserting anvil fork into esophageal lumen at first attempt was 97.4%. The total operation time, esophagojejunostomy time, volume of intraoperative blood loss, and length of surgical incision were 317.6 ± 51.5 min, 20.8 ± 3.8 min, 50.0 (range 15.0–200.0) ml, and 5.0 (range 4.0–8.0) cm, respectively. No procedures were converted to other laparoscopic anastomosis techniques or open approaches. The time to postoperative initial flatus, liquid diet intake, soft diet intake, and length of postoperative hospital stay were 3.0 (range 1.0–6.0) days, 4.0 (range 2.0–9.0)days, 6.0 (range 3.0–11.0) days, and 8.5 (range 6.0–16.0) days, respectively. Overall, postoperative complications were observed in 8 (21.1%) patients. Among them, one patients developed esophagojejunal anastomotic leakage. After 3 months of follow-up, none of the patients developed anastomotic stenosis or experienced unplanned secondary surgery or perioperative death. Conclusions OGT-assisted overlap esophagojejunostomy for patients with G/GEJ tumors is safe and feasible, with good short-term effects. OGT method has a satisfactory success rate of inserting anvil fork into esophageal lumen at first attempt and could prevent from developing esophageal submucosa pseudocanals.

A case series of 10 patients undergone linear cutter/stapler guiding device-led overlapped esophagojejunostomy: a preliminary study

“…During the traditional overlap anastomosis, the entry of reload into the jejunal side is usually required to prevent the relatively sharp anvil from piercing the jejunum, which, however, may also bring the relatively thick reload into the jejunal side, leading to a long common opening ( 8 ). It is well known that a longer jejunal margin greatly increases the chance and degree of jejunal mucosal exstrophy, thus impacting the quality and speed of closing the common opening.…”

Application of a New Retraction Method in Laparoscopic Gastrectomy for Gastric Cancer

“…The overlap operation is technically difficult and time-consuming and may result in some unique complications, such as the formation of esophageal submucosa pseudocanals. 17 Gastric tube guidance can assist the stability of the anvil fork entering the esophageal mucosa canal, and shorten the length of the esophageal stump hole. Finally, the common hole was closed with full-thickness running sutures using barbed sutures intracorporeally.…”

“…Finally, the common hole was closed with full-thickness running sutures using barbed sutures intracorporeally. 17 By continuously tracking the esophagus with the internal retractor, the assistant's hands can be free to help the operator. The left hand of the assistant uses the forceps to lift the gastric tube outside the esophageal stump, meanwhile, the right hand cooperates with the operator's left hand reversely clip the esophagus opening to form a triangle, which can expose the esophageal lumen.…”

“…In my center, Endo-GIA was routinely inserted into the esophagus, guided by a gastric tube during overlap anastomosis. The overlap operation is technically difficult and time-consuming and may result in some unique complications, such as the formation of esophageal submucosa pseudocanals 17 . Gastric tube guidance can assist the stability of the anvil fork entering the esophageal mucosa canal, and shorten the length of the esophageal stump hole.…”

“…Gastric tube guidance can assist the stability of the anvil fork entering the esophageal mucosa canal, and shorten the length of the esophageal stump hole. Finally, the common hole was closed with full-thickness running sutures using barbed sutures intracorporeally 17 . By continuously tracking the esophagus with the internal retractor, the assistant’s hands can be free to help the operator.…”