Modifications to the double-staple technique for oesophago-jejunal anastomosis

A new instrument is described that makes a small modification to the anvil of an Ethicon circular stapler, allowing it to be more easily withdrawn through a cross-stapled oesophagus. This allows the double-stapling technique for oesophago-jejunal anastomoses to be completed safely through the hiatus, even many centimetres inside the chest. The technique has been used on 17 anastomoses without difficulty, clinical leak or subsequent stricture. Several of these patients would have needed a thoracotomy to complete the anastomosis had it not been for this instrument.