Related Experiment Video
Updated: May 15, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Stable purse-string suturing using an anterior esophagotomy for reconstruction with a circular stapler during
Seong-Ho Kong1, Yunsuhk Suh, Sebastianus Kwon
1Department of Surgery, Seoul National University Hospital, Seoul, Korea.
Introduction:
During a laparoscopic total gastrectomy, the combined process of purse-string suture placement and anvil insertion of a circular stapler is one of the most difficult steps in the reconstruction. We have developed a stable and reliable technique in which purse-string suture placement and anvil insertion using anterior esophagotomy precede complete transection of the esophagus.
Methods:
The procedure involves tying the distal esophagus, insufflating the esophagus via a nasogastric tube, anterior wall purse-string suture, anterior esophagotomy, posterior wall purse-string suture, anvil insertion, fastening purse-string suture, and transecting the esophagus. The technique has been employed in nine patients since April 2011.
Results:
Eight of the nine gastrectomies were for patients with stage IA early gastric cancer and one was for a patient with medically intractable bleeding from multiple polyps. Three were men and six were women. Average BMI was 25.2 ± 5.3 (range, 16.3-33.9). Mean operation time was 276.2 ± 56.3 min (range, 215.0-395.0 min) and the mean duration for anvil insertion was 29.8 ± 7.0 min (range, 23.0-46.0 min). There were no intraoperative or postoperative anastomosis-related complications or mortality.
Conclusion:
Our method of anvil insertion of a circular stapler can be a good option for safe and reliable esophagojejunostomy during a laparoscopic total gastrectomy.
