Short-term outcomes of different esophagojejunal anastomotic techniques during laparoscopic total gastrectomy: a network meta-analysis

Aiolfi, Alberto; Sozzi, Andrea; Bonitta, Gianluca; Lombardo, Francesca; Cavalli, Marta; Campanelli, G.; Bonavina, Luigi; Bona, Davide

doi:10.1007/s00464-023-10231-6

Cited by 5 publications

(4 citation statements)

References 65 publications

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“…A wide variety of intracorporeal anastomosis techniques have been developed and can be performed manually or with a stapler. Double stapling and hemi-double stapling techniques are techniques using double staplers without a need for purse-string suture and with ease of application [ 22 , 36 , 37 , 38 ]. In the double stapling technique (DST), the rod of the anvil is located at the centre of the linear staple line.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Aiolfi et al from the University of Milan published a systematic review and meta-analysis of esophagojejunal anastomotic techniques [ 22 ]. In the meta-analysis, they noted that anastomosis-related complications may not reflect the quality of a particular technique and are influenced by surgeon skill, learning curves, and hospital volume.…”

Section: Discussionmentioning

confidence: 99%

“…Surgeons have used a variety of reconstruction methods, but there is no standard method for esophagojejunostomy. To find a simple and easy-to-perform method, different reconstruction methods have been used in the literature and evaluated in terms of anastomotic leakage, anastomotic stenosis, postoperative dysphagia, reflux, operative time and cost [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Mechanical staplers are widely used for safety and time-saving.…”

Section: Introductionmentioning

confidence: 99%

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Hemidouble Stapling Technique versus Ghosting Double Stapling Technique for Esophagojejunostomy after Laparoscopic Total Gastrectomy

Senol,

Karagul

2024

JPM

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The hemidouble stapler technique (HDST) in laparoscopic intracorporeal esophagojejunostomy has aspects that pose risks to the safety of the anastomosis. We developed a new esophagojejunostomy technique that converts a double-stapled anastomosis to a single-stapled anastomosis in laparoscopic total gastrectomy (LTG). The aim of this study is to compare the results of two techniques. Patients who underwent LTG for gastric cancer in our hospital between October 2016 and May 2022 were included in the study. Patients were retrospectively reviewed in two groups: those who underwent HDST and the ghosting double stapling technique (GDST). Both groups were analysed in terms of demographics, perioperative findings, and postoperative outcomes. The GDST was used in 14 patients. The HDST was used on 16 patients. Two patients in the HDST group whose esophagojejunal anastomosis was not assessed on endoscopic imaging were excluded. The mean total operative times were 292.6 ± 43.7 and 224.3 ± 36.1 min (p < 0.001). The mean times for esophagojejunostomy were 38.6 ± 4.3 and 26.8 ± 6.4 min (p < 0.001). One case of anastomotic stenosis was observed in the HDST group. Anastomotic leakage was not observed in both groups. However, there was no significant difference in overall morbidity between the groups (p > 0.05). Both HDST and GDST can be safely performed in the esophagojejunostomy for LTG.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hemidouble Stapling Technique versus Ghosting Double Stapling Technique for Esophagojejunostomy after Laparoscopic Total Gastrectomy

Senol,

Karagul

2024

JPM

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“…A recent meta-analysis including 3,177 patients found similar AL rate, no matter the technique of anastomosis after laparoscopic gastrectomy [69].…”

Section: Reconstruction Type Eso-jejuno-anastomosismentioning

confidence: 94%

Anastomotic Leakage after Gastrectomy for Gastric Cancer

Seicean,

Puscasu,

Gheorghiu

et al. 2023

JGLD

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Anastomotic leakage (AL) constitutes a prominent cause of significant morbidity following gastrectomy for gastric cancer. The manifestation of AL typically occurs within 7 to 10 days post-surgery, with reported incidence rates of 5.8-6.7% for open gastrectomy and 3.3-4.1% for laparoscopic gastrectomy. Various predisposing risk factors have been identified, including the individual nutritional status (excluding obesity) and preoperative corticotherapy. Interestingly, the administration of neoadjuvant therapies appears to reduce the AL occurrence. In the context of distal gastrectomies, the rates of AL are comparable between laparoscopic, robotic, and open approaches. The total gastrectomies have higher AL rate compared to distal gastrectomies, which are considered the preferred approach. Prophylactic drainage measures have not demonstrated efficacy in preventing AL. As for postoperative management, conservative treatment is indicated for patients presenting with mild clinical symptoms and increased inflammatory blood tests. This approach involves fasting, enteral or parenteral nutrition, administration of antibiotics, and percutaneous drainage. For small AL, endoscopic therapies such as stents, vacuum therapy, clips, suturing devices, and injections are appropriate treatment options. In cases of high-volume fistulas, severe sepsis or failure of previous therapies, surgical reoperation becomes the ultimate solution.

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Catheter-guided anvil insertion for circular stapler esophagojejunal anastomosis: a novel technique in laparoscopic total gastrectomy

Ye,

Yu,

Cao

et al. 2024

Updates Surg

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Objective This study evaluates feasibility, safety, and short-term outcomes of employing the catheter-guided stapler anvil insertion technique for esophagojejunal anastomosis using a circular stapler during laparoscopic total gastrectomy (LTG). Materials and methods From September 2021 to April 2023, the catheter-guided stapler anvil insertion technique was employed in 80 patients undergoing laparoscopic total gastrectomy (LTG) for esophagojejunal anastomosis. A modified D2 dissection, according to the en bloc technique, was performed in the patients. Subsequently, a longitudinal incision, approximately 2 cm in length, was made on the anterior wall of the esophagus, about 2 cm above the tumor. The transection line was pre-marked with blue dye along the esophagus's minor axis, and the tail of the anvil was capped with a 10-cm length of catheter (F14 d4.7 mm). The surgeon secures the head of anvil and carefully inserts it into the esophagus, ensuring that only a 5-cm segment of the catheter remains outside the esophagus. A linear cutter was employed to transect and seal the lower end of the esophagus. Subsequently, esophagojejunostomy was performed under laparoscopic guidance using a circular stapler. Results Among patients undergoing esophagojejunal anastomosis with the new technique, postoperative complications included pneumonia or pleural effusion in 14 patients (17.5%), anastomotic stenosis in 3 patients (3.75%), abdominal infection in 2 patients (2.5%), and intestinal obstruction in 1 patient (1.25%). No instances of anastomotic leakage, anastomotic bleeding, or deaths were recorded. All patients experiencing complications improved with conservative treatment, without the need for secondary surgery. Conclusion The catheter-guided stapler anvil insertion technique is demonstrated to be a safe and effective method for esophagojejunostomy, potentially reducing the occurrence of anastomotic leakage.

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Short-term outcomes of different esophagojejunal anastomotic techniques during laparoscopic total gastrectomy: a network meta-analysis

Cited by 5 publications

References 65 publications

Hemidouble Stapling Technique versus Ghosting Double Stapling Technique for Esophagojejunostomy after Laparoscopic Total Gastrectomy

Hemidouble Stapling Technique versus Ghosting Double Stapling Technique for Esophagojejunostomy after Laparoscopic Total Gastrectomy

Anastomotic Leakage after Gastrectomy for Gastric Cancer

Catheter-guided anvil insertion for circular stapler esophagojejunal anastomosis: a novel technique in laparoscopic total gastrectomy

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