Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kanagawa, Japan.
Esophagus. 2018 Apr;15(2):88-94. doi: 10.1007/s10388-017-0599-z. Epub 2017 Dec 16.
Esophagogastric anastomosis performed after esophagectomy is technically complex and often the source of postoperative complications. The best technique for this anastomosis remains a matter of debate. We describe a new all-stapled side-to-side anastomosis, which we refer to as triple-stapled quadrilateral anastomosis (TRIQ), that can be performed after minimally invasive surgery, and we report results of a retrospective evaluation of postoperative outcomes among the 60 patients in whom this anastomosis has been performed thus far.
The anastomosis is created by apposition of the posterior walls of the esophagus and stomach. A linear stapler is applied to create a V-shaped posterior anastomotic wall. The anterior wall is closed in a gentle chevron-like shape with the use of 2 separate linear staplers, resulting in a wide quadrilateral anastomosis. The anastomosis is then wrapped with a greater omentum flap.
The patient group comprised 48 men and 12 women with a mean age of 67.8 years. Neoadjuvant chemotherapy was performed in 43 of these patients. Neither the thoracoscopic or laparoscopic procedure was converted to open surgery in any patient. The median operation time was 474 min (range 680-320 min). The intraoperative blood loss volume was 104.4 mL (range 240-30 mL). There were no anastomosis-related complications above Clavien-Dindo grade II.
TRIQ can be performed easily and safely, and good short-term outcome can be expected.
食管切除术后进行的食管胃吻合术技术复杂，往往是术后并发症的根源。这种吻合术的最佳技术仍然存在争议。我们描述了一种新的全吻合器侧侧吻合术，我们称之为三联吻合四边形吻合术（TRIQ），可以在微创手术后进行，我们报告了迄今为止已完成该吻合术的 60 例患者的术后结果的回顾性评估结果。
吻合术通过食管和胃的后壁贴合来完成。使用线性吻合器创建 V 形后吻合壁。前壁用 2 个单独的线性吻合器以柔和的人字形形状关闭，形成宽阔的四边形吻合术。然后用大网膜瓣包裹吻合术。
患者组包括 48 名男性和 12 名女性，平均年龄为 67.8 岁。这些患者中有 43 人接受了新辅助化疗。没有患者的胸腔镜或腹腔镜手术被转换为开放性手术。中位手术时间为 474 分钟（范围 680-320 分钟）。术中失血量为 104.4 毫升（范围 240-30 毫升）。没有发生 II 级以上的吻合相关并发症。
TRIQ 可以安全、容易地进行，并且可以预期有良好的短期结果。
