Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.
J Laparoendosc Adv Surg Tech A. 2023 Aug;33(8):801-806. doi: 10.1089/lap.2022.0593. Epub 2023 Apr 13.
The lack of tension at the anastomosis site and the blood flow of the gastric conduit are important to prevent anastomotic leakage in the anastomosis of the esophagogastric conduit. This study reports a gastric conduit stump closure method using Endo GIA™ Radial Reload in end-to-side anastomosis of the esophagogastric conduit, especially focusing on blood flow. A 4-cm conduit was created to ensure an intramural vascular network. The gastric conduit was elevated to the neck through the posterior mediastinal route, and end-to-side anastomosis of the esophagus and gastric conduit was performed using a circular stapler. Closure of the gastric stump with an Endo GIA Radial Reload was performed 2 cm proximal to the anastomosis on the end side of the esophagogastric conduit. The lesser curvature of the stump of the gastric conduit is the most frequent site of anastomotic leakage as it has the least blood flow, and the pressure is highest when the pressure inside the gastric conduit increases. Therefore, the gastric conduit stump was closed using the Endo GIA Radial Reload to resect the intersection of the gastric stump and lesser curvature from which the gastric conduit was created. The gastric conduit stump is gently curved; therefore, the pressure applied to the gastric conduit stump could be dispersed when the intragastric pressure increases. No anastomotic leakage was observed among the 21 patients who underwent this method. This method is a novel anastomosis method to prevent anastomotic leakage in an end-to-side anastomosis of the esophagogastric conduit.
吻合口处无张力和胃管的血流对于防止胃食管吻合口漏至关重要。本研究报告了一种使用 Endo GIA™ Radial Reload 进行胃管残端闭合的方法，用于胃食管吻合口的端侧吻合，尤其注重血流。创建一个 4cm 的管腔以确保存在壁内血管网络。通过后纵隔途径将胃管提升至颈部，并使用圆形吻合器进行食管和胃管的端侧吻合。在胃食管吻合口的端侧，距吻合口近端 2cm 处使用 Endo GIA Radial Reload 闭合胃残端。由于胃管残端的小弯侧血流最少，并且当胃管内压力增加时压力最高，因此该部位是吻合口漏最常见的部位。因此，使用 Endo GIA Radial Reload 闭合胃管残端，切除胃管残端和小弯侧的交点，该交点是创建胃管的部位。胃管残端被轻轻弯曲；因此，当胃内压增加时，施加在胃管残端上的压力可以分散。采用这种方法的 21 例患者均未发生吻合口漏。这种方法是一种预防胃食管吻合口端侧吻合口漏的新型吻合方法。
