Experiences with the linear cutter technique for performing Roux-en-Y anastomosis following total gastrectomy.

The use of stapling devices for performing gastro-intestinal anastomosis has recently gained wide acceptance. In fact, since 1991, we have been using linear cutter devices for performing the Roux-en-Y anastomosis, transection of the duodenum, and closure of the jejunal stump (except following esophagojejunostomy), and are no longer employing hand-sewn procedures. In this report, the linear cutter technique used after total gastrectomy is described and the differences in anastomotic leakage, morbidity, operating time, and reconstruction time are evaluated in comparison with those following hand-sewn anastomoses. A total of 22 patients undergoing total gastrectomy within a 2-year period were randomized into two groups of 11, to have reconstruction performed by either a stapled or hand-sewn Roux-en-Y anastomosis. One patient from the stapled group died of acute myocardial infarction 6 days after the operation. Anastomotic leakages from the esophagojejunostomy region occurred in 18% of the patients in the stapled group, but fortunately no leakage was apparent from the Y-anastomosis when the linear cutter technique was used. The most obvious significance was the short mean reconstruction time in the stapled group of 19.1 +/- 3.56 min (P < 0.01) being 31 min shorter than that of the hand-sewn group (n = 11). Thus, we proposed that the linear cutter technique is a safe technique for performing anastomosis following total gastrectomy, which would significantly reduce the reconstruction time.