Efficacy of a linear stapler in entry hole closure during overlap anastomosis in minimally invasive gastrectomy

Yuki Azumi; Naoki Urakawa; Shingo Kanaji; Hiroki Yokoo; Atsushi Shimada; Ryuichiro Sawada; Taro Ikeda; Yasufumi Koterazawa; Tomoaki Aoki; Hitoshi Harada; Yasunori Otowa; Hironobu Goto; Hiroshi Hasegawa; Kimihiro Yamashita; Takeru Matsuda; Yoshihiro Kakeji

doi:10.1007/s00464-025-11736-y

Efficacy of a linear stapler in entry hole closure during overlap anastomosis in minimally invasive gastrectomy

Surg Endosc. 2025 May;39(5):3346-3353. doi: 10.1007/s00464-025-11736-y. Epub 2025 Apr 17.

Authors

Affiliations

¹ Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan.
² Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan. urakawa@med.kobe-u.ac.jp.
³ Division of Analytical Biomedical Sciences, Department of Biophysics, Graduate School of Health Sciences, Kobe University, Kobe, Japan.

PMID: 40246760
DOI: 10.1007/s00464-025-11736-y

Abstract

Background: Overlap anastomosis is widely used in gastrointestinal reconstruction during minimally invasive gastrectomy. The entry hole of the anastomosis is typically closed with hand-sewn sutures because of concerns about stenosis. This study aimed to compare the efficacy of linear stapler (LS) closure with that of hand-sewn closure of the entry hole in overlap anastomosis.

Methods: We included 172 patients who underwent overlap anastomosis during laparoscopic or robot-assisted total gastrectomy (TG, Roux-en-Y) or distal gastrectomy (DG, Roux-en-Y/Billroth II) between February 2020 and September 2024. The patients were divided into two groups based on the method of entry hole closure: the suturing group (S group) and the LS group. Surgical outcomes were retrospectively analyzed.

Results: There were no significant differences in patient characteristics or tumor staging between the two groups. TG was performed in 46 and 17 patients in the S and LS groups, respectively, whereas DG was performed in 41 and 68 patients in the S and LS groups, respectively. In TG patients, there was no significant difference in operative time, but the esophageal-jejunal overlap anastomosis time was significantly shorter in the LS group (38.3 vs. 20.5 min, P < 0.001). The incidence of postoperative complications was similar in both groups, and no cases of stenosis were observed in the LS group. In DG patients, the operative time and gastric-jejunal overlap anastomosis time were significantly shorter in the LS group (294 min vs. 253 min, P = 0.002; 28.5 vs. 9.0 min, P < 0.001). The length of postoperative hospital stay was significantly shorter in the LS group (13 vs. 11 days, P = 0.01).

Conclusion: Using an LS to close the entry hole in an overlapping anastomosis during minimally invasive gastrectomy can reduce the anastomosis time and may be a safe option without increasing the risk of stenosis.

Keywords: Gastric cancer; Minimally invasive surgery; Overlap method; Reconstruction.

Publication types

Comparative Study

MeSH terms

Aged
Anastomosis, Roux-en-Y / methods
Anastomosis, Surgical / instrumentation
Anastomosis, Surgical / methods
Female
Gastrectomy* / adverse effects
Gastrectomy* / instrumentation
Gastrectomy* / methods
Humans
Jejunum / surgery
Laparoscopy* / adverse effects
Laparoscopy* / methods
Male
Middle Aged
Operative Time
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Robotic Surgical Procedures / methods
Stomach Neoplasms* / surgery
Surgical Staplers*
Surgical Stapling* / instrumentation
Surgical Stapling* / methods
Suture Techniques* / instrumentation
Treatment Outcome