Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Asian J Endosc Surg. 2020 Apr;13(2):168-174. doi: 10.1111/ases.12716. Epub 2019 May 16.
A transorally inserted anvil has been developed to facilitate the creation of a stapled anastomosis without the need for a purse string to secure the anvil into place during laparoscopic total gastrectomy (LTG). We describe a hemi-double stapling technique and application of a transorally inserted anvil for esophagojejunostomy during LTG, and we report the results of a retrospective study in which we examined the feasibility and safety of this method. We also describe the key technical details of the method.
Our anastomotic method has four chief features: (a) the esophagus is cut at a slant, and its left cut end is cut and punched for the hemi-double stapling technique; (b) the anvil and circular stapler are connected, placing the distal jejunum in cranial traction; (c) a single layer of sutures is used to correct dog-earing and overlapping, and these points are completely closed with Lembert sutures; and (d) the jejunal limb is fixed to the duodenal stump to prevent kinking of the jejunal limb and to decrease tension on the anastomosis.
This method has been used in 53 patients thus far. LTG with Roux-en-Y reconstruction was successful in all patients, and there was no need for conversion to open surgery. The mean operative time was 313 minutes, and the mean blood loss was 106 mL. The mean postoperative hospital stay was 18 days. There was no anastomotic leakage or stenosis.
Hemi-double stapling technique with a transorally inserted anvil for LTG can be performed safely and easily and safely. It can also product good outcomes.
为了在腹腔镜全胃切除术（LTG）中无需使用荷包缝线固定吻合器，一种经口插入的吻合器已被开发出来以方便吻合器吻合的创建。我们描述了一种半双吻合技术和经口插入吻合器在 LTG 中用于食管空肠吻合的应用，并报告了一项回顾性研究的结果，该研究检查了这种方法的可行性和安全性。我们还描述了该方法的关键技术细节。
我们的吻合方法有四个主要特点：（a）食管斜切，左切端切割并打孔用于半双吻合技术；（b）吻合器和圆形吻合器连接，将空肠远端置于颅侧牵引；（c）使用单层缝线纠正狗耳和重叠，并使用 Lembert 缝线完全关闭这些部位；（d）将空肠支固定在十二指肠残端上，以防止空肠支扭曲并减少吻合口张力。
迄今为止，该方法已在 53 例患者中使用。所有患者均成功进行了 LTG 加 Roux-en-Y 重建，无需转为开放性手术。平均手术时间为 313 分钟，平均出血量为 106 毫升。平均术后住院时间为 18 天。无吻合口漏或狭窄。
用于 LTG 的经口插入吻合器半双吻合技术可以安全、轻松地进行，并且可以获得良好的效果。
