A Novel Technique of Hand-Sewn Purse-String Suturing by Double Ligation Method (DLM) for Intracorporeal Circular Esophagojejunostomy

Yuichi Takayama; Yuji Kaneoka; Atsuyuki Maeda; Yasuyuki Fukami; Takamasa Takahashi; Masahito Uji

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자료유형: 학술저널

저자정보: Yuichi Takayama Yuji Kaneoka Atsuyuki Maeda Yasuyuki Fukami Takamasa Takahashi Masahito Uji

저널정보: 대한위암학회 Journal of Gastric Cancer Journal of Gastric Cancer 제19권 제3호

발행연도: 2019.1

수록면: 290 - 300 (11page)

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Purpose: The optimal method for intracorporeal esophagojejunostomy remains unclearbecause a purse-string suture for fixing the anvil into the esophagus is difficult to performwith a laparoscopic approach. Therefore, this study aimed to evaluate our novel technique tofix the anvil into the esophagus. Materials and Methods: This retrospective study included 202 patients who were treatedat our institution with an intracorporeal circular esophagojejunostomy in a laparoscopyassistedtotal gastrectomy with a Roux-en-Y reconstruction (166 cases) or a laparoscopyassistedproximal gastrectomy with jejunal interposition (36 cases). After incising 3/4 ofthe 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 circularesophagojejunostomy was performed laparoscopically. The clinical characteristics andsurgical outcomes were evaluated and compared with those of other methods. Results: The average operation time was 200.3 minutes. The average hand-sewn pursestringsuturing time was 6.4 minutes. The overall incidence of postoperative complications(Clavien–Dindo classification grade ≥II) was 26%. The number of patients with ananastomotic leakage and stenosis at the esophagojejunostomy site were 4 (2.0%) and 12(6.0%), respectively. All patients with stenosis were successfully treated by endoscopicballoon dilatation. There was no mortality. Regarding the materials and devices for anvilfixation, only 1 absorbable thread was needed. Conclusions: Our procedure for hand-sewn purse-string suturing with the double ligationmethod is simple and safe.

참고문헌 (30)

참고문헌 신청

Katai H / 2010 / Safety and feasibility of laparoscopyassisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703) / Gastric Cancer 13:238~244

Kitano S / 2007 / A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan / Ann Surg 245:68~72

Fukunaga T / 2013 / Oncologic outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer / Ann Surg Oncol 20:2676~2682

Jeong O / 2009 / Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy / Surg Endosc 23:2624~2630

Fujimoto S / 1991 / Stapled or manual suturing in esophagojejunostomy after total gastrectomy: a comparison of outcome in 379 patients / Am J Surg 162:256~259

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