Intracorporeal circular‐stapled anastomosis after totally laparoscopic gastrectomy: A novel, simplest u‐shaped parallel purse‐string suture technique

Abstract

Background Intracorporeal anastomoses in totally laparoscopic gastrectomy (TLG) remain technical challenges to many surgeons, although the intracorporeal jejunojejunal or gastrojejunal anastomosis is an essential procedure during TLG. Standardized, reproducible and simple circular‐stapled anastomosis in open gastrectomy is limited in TLG due to the difficulties of intracorporeal purse‐string suture or anvil placement. An optimal procedure for intracorporeal anastomosis in TLG remains to be established. Methods Between February 2018 and January 2019, 31 consecutive patients with gastric cancer underwent totally laparoscopic total gastrectomy (TLTG) or totally laparoscopic distal gastrectomy (TLDG) using the novel u‐shaped parallel purse‐string suture technique along the jejunum for anvil placement. The intracorporeal circular‐stapled jejunojejunostomy of Roux‐en‐Y reconstruction in TLTG and gastrojejunostomy of Billroth II in TLDG were, respectively, performed. Results The total mean ± SD operative time was 214.7 ± 48.6 minutes. The time required for purse‐string suture and anvil placement was 2.3 ± 0.5 and 4.4 ± 1.1 minutes, respectively. There were no instances of postoperative jejunojejunal or gastrojejunal anastomosis‐related complications observed during the median follow‐up period of 5.5 months. Conclusions The novel procedure conceptionally and technically changes the conventional circular‐shaped purse‐string suture into a much simpler way, u‐shaped parallel purse‐string suture. This could be the simplest published intracorporeal pure‐string suture technique

Esophageal Suspension Method for Hand-Sewn Esophagojejunostomy After Totally Laparoscopic Total Gastrectomy: A Simple, Safe, and Feasible Suturing Technique

“…In addition, TLG in intracorporeal anastomosis had the advantages of high safety, less adhesion, rapid recovery, and small scars (29,30). At present, the related literature (9)(10)(11)(12)(13) reports that esophagojejunostomy is mainly performed with circular and linear staplers. In fact, a variety of techniques for esophagojejunostomy have emerged in recent years, but none of them was considered as the standard technique (31).…”

“…Currently, relevant literature (9)(10)(11)(12)(13) reports that esophagojejunostomy is mainly performed with circular and linear staplers. The former mainly includes the transorally inserted anvil (OrVil TM ), reverse puncture device (RPD), and purse-string suture method; the latter mainly includes functional end-to-end (FETE), overlap anastomosis, π-shaped esophagojejunostomy and semi-end-to-end anastomosis.…”

Handover method: Simple, classic and harmonized intracorporeal closure of stapled duodenal stump during laparoscopic gastrectomy

“…Subsequently, the 25 mm circular‐stapled gastrojejunostomy was completed. Finally, circular‐stapled jejunojejunostomy in TLTG and TLDG was respectively performed to complete each Roux‐en‐Y in TLTG and TLDG when anvil placement was completed following creation of a hand‐sewn purse‐string suture along the jejunum using the u‐shaped parallel purse‐string suture technique reported in 2019 16 . The mesenteric defect between the jejunojejunostomy was closed using laparoscopic hand‐sewn suture.…”

Modified π-shaped Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy: a Report of 40 Consecutive Cases From a Single Center

“…Anastomosis with circular stapler that resembles conventional open gastrectomy is associated with advanced technical demands in complex purse-string suture and anvil placement during a laparoscopic procedure, although various methods have been introduced. [4,5] In contrast, linear stapler has proven to be more handlerfriendly with favorable clinical outcomes in safety and feasibility. [6] To date, there is still no standard esophagojejunostomy anastomosis method for TLTG using linear staplers.…”