Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy

Zuiki, Toru; Hosoya, Yoshinori; Kaneda, Yuji; Kurashina, Kentaro; Saito, Shin; Ui, Takashi; Higashi, Hidenori; Hyodo, Masanobu; Sata, Naohiro; Lefor, Alan Kawarai; Yasuda, Yoshikazu

doi:10.1007/s00464-013-2945-0

Cited by 65 publications

(69 citation statements)

References 29 publications

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“…Previous reports describing 15 or more patients who underwent LATG with esophagojejunostomy using OrVil TM reported anastomotic stricture rates of 0-21 % [21][22][23]. These strictures may be due to ischemia at the site where the staple lines meet, leading to fibrosis [23]. In addition, when the pretilted anvil is tilted back into the flat Fig.…”

Section: Discussionmentioning

confidence: 99%

Potential benefits of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy for cT1 upper-third gastric cancer

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Potential benefits of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy for cT1 upper-third gastric cancer

et al. 2015

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“…In addition, forming anastomoses using the OrVil TM has some disadvantages. In spite of the requirement for precise manipulations mentioned above, the incidence of anastomotic leakage and the incidence of stenosis were relatively high compared with results seen with use of the other devices [62], so improvements to this device should be considered. It may be difficult to arrive at one uniform method for performing intracorporeal esophagojejunostomy using a circular stapler.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of laparoscopic total gastrectomy for gastric cancer

et al. 2015

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Background Laparoscopic total gastrectomy (LTG) has been performed since 1999. Although surgical outcomes have been reported from Japan, Korea, China, and many Western countries, the effectiveness of this technique has not been conclusively established. This study therefore aimed to review the literature systematically. Methods Our search of the research literature identified 150 studies, which were mostly retrospective and from single institutions. Results There has recently been a remarkable increase in the number of studies from Korea, and the number of patients included in studies has increased since 2009. In most studies, the surgical procedures were longer, blood loss was reduced, and the number of retrieved lymph nodes was the same in the LTG group as in the open total gastrectomy group. The incidence of postoperative complications and that of inflammation during postoperative recovery were the same in these two groups. Conclusions During LTG, the method used for esophagojejunostomy is important for surgical reliability and to reduce postoperative complications. There has been rapid development of new techniques from the level of esophagojejunostomy through a small skin incision to the high level of intracorporeal esophagojejunostomy using various techniques. A nationwide prospective phase II study is urgently needed to establish the value of LTG.

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“…In our series, we examined anastomotic leak and stricture after DST for gastric cancer, which in the literature can occur in up to 17 % 2 , 10–13 and 33 % 2 , 5 , 7 , 10–12 , 14 of patients, respectively. In our study, the leak rate was 6.7 % and the stricture rate independent of leak was 19.0 %.…”

Section: Discussionmentioning

confidence: 99%

“…Either anastomotic technique (hand-sewn or stapled) can be challenging in a minimally invasive approach. Although many solutions have been proposed to manage the technical challenges, 1–7 there is no universally accepted method to create the esophagoenteric anastomosis with laparoscopic or robotic gastrectomy. The double-staple technique (DST), which can be used in either open or totally laparoscopic approaches, facilitates the creation of the esophagoenteric anastomosis by precluding the need for suture anastomosis or creation of a purse-string.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Double-Staple Technique for Esophagoenteric Anastomosis in Gastric Cancer

Choi

Arrington

Falor

et al. 2016

Journal of Gastrointestinal Surgery

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Introduction Reports on outcomes after double-staple technique (DST) for total and proximal gastrectomy are limited, originating mostly from Asian centers. Our objective was to examine anastomotic leak and stricture with DST for esophagoenteric anastomosis in gastric cancer patients. Methods A single institution review was performed for patients who underwent total/proximal gastrectomy with DST between 2006 and 2015. DST was performed using transoral anvil delivery (OrVil™) with end-to-end anastomosis. Clinical characteristics and outcomes, including anastomotic leak and stricture, were recorded. Results Overall, DST was performed in 60 patients [total gastrectomy (81.7 %, n = 49/60), proximal gastrectomy (10.0 %, n=6/60), and completion gastrectomy (8.3 %, n =5/60)]. Neoadjuvant chemotherapy was administered to 21 patients (35.0 %), and 6 patients (10.0 %) received external beam radiation therapy prior to completion gastrectomy. Operative approach was open (51.7 %, n = 31/60), laparoscopic (43.3 %, n =26/60), or robotic (5.0 %, n = 3/60). Anastomotic leak occurred in 6.7 % (n=4/60), while stricture independent of leak was identified in 19.0 % (n =11/58) of patients. Complications occurred in 38.3 % (n =23/60) of patients, of which 52 % were classified as Clavien-Dindo grades III–V complications. Conclusion In the largest Western series of DST for esophagoenteric anastomoses in gastric cancer surgery, our experience demonstrates that DST is safe and effective with low rates of leak and stricture.

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Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy

Abstract: Esophagojejunostomy using DST with OrVil is useful in performing a minimally invasive procedure but carries a high risk of anastomotic stenosis.

Cited by 65 publications

References 29 publications

Potential benefits of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy for cT1 upper-third gastric cancer

Potential benefits of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy for cT1 upper-third gastric cancer

A systematic review of laparoscopic total gastrectomy for gastric cancer

Assessment of the Double-Staple Technique for Esophagoenteric Anastomosis in Gastric Cancer

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