Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 21 (4), 712-722

Linear-Stapled Side-to-Side Esophagojejunostomy With Hand-Sewn Closure of the Common Enterotomy After Prophylactic and Therapeutic Total Gastrectomy

Affiliations

Linear-Stapled Side-to-Side Esophagojejunostomy With Hand-Sewn Closure of the Common Enterotomy After Prophylactic and Therapeutic Total Gastrectomy

Kevin K Chang et al. J Gastrointest Surg.

Abstract

After total gastrectomy, anastomosis-related complications such as leak or stricture can be highly morbid. Between July 2005 and December 2015, a linear-stapled side-to-side esophagojejunostomy with hand-sewn closure of the common enterotomy (modified Orringer technique) was used for Roux-en-Y reconstruction after prophylactic total gastrectomy in 22 germline CDH1 mutation carriers and after therapeutic total gastrectomy in 18 patients diagnosed with gastric adenocarcinoma. All operations were performed by the same surgeon. No patient in either cohort developed a clinically evident anastomotic leak, one patient (2.5%) developed a contained radiographic leak that healed without intervention, and one patient (2.5%) developed an anastomotic stricture treated by endoscopic dilatation 7 months after operation. These rates were lower than radiographic leak and stricture rates in a comparison group of 32 patients who received a completely hand-sewn esophagojejunostomy (6.3 and 3.1%, respectively). Here, we describe how to perform the linear-stapled esophagojejunostomy anastomosis.

Keywords: Anastomotic leak; Anastomotic stricture; CDH1 mutation; Esophagojejunostomy; Gastric adenocarcinoma; Hereditary diffuse gastric cancer; Total gastrectomy.

Conflict of interest statement

Disclosures: The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) The distal esophagus is mobilized to a length of 6 to 8 cm above the gastroesophageal junction. (b)Two stay sutures of 3-0 silk are placed 15-20 mm apart in the midportion of the esophageal staple line. In preparation for the anastomosis, a 10 mm esophagotomy will be created in between the stay sutures by cutting out the three rows of staples. (c)The lumen of the esophagus with whitish mucosa is demonstrated. (d) To prevent false passage of the stapler anvil, the layers of the esophageal wall are sutured together. The two anastomotic stay sutures and the suture through the anterior wall layers are visible.
Figure 2
Figure 2
(a) The large jaw of the Endo GIA™ stapler with a 45 mm medium/thick (purple) reload is placed into the enterotomy created on the antimesenteric border of the jejunal Roux limb approximately 6 cm distal to the transection staple line. (b) The small jaw of the stapler is placed into the esophageal lumen. (c) The common enterotomy is closed with hand-sewn, interrupted 3-0 silk sutures in a single-layer fashion. (d) The completed esophagojejunal anastomosis with hand-sewn closure of the common enterotomy.
Figure 3
Figure 3. (a)-(f) Line drawings demonstrating performance of the esophagojejunostomy anastamosis

Similar articles

See all similar articles

MeSH terms

Feedback