Problems associated with the EEA stapling technique for esophagojejunostomy after total gastrectomy.

Area of Science:

• Gastrointestinal Surgery
• Surgical Oncology
• Medical Devices

Background:

• Total gastrectomy for gastric cancer necessitates reconstruction of the gastrointestinal tract.
• End-to-side esophagojejunostomy is a common reconstruction method.
• The EEA stapling device facilitates this anastomosis.

Purpose of the Study:

• To evaluate the safety and efficacy of the EEA stapling device for end-to-side esophagojejunostomy.
• To analyze the incidence and types of immediate and delayed complications.
• To assess the management and outcomes of these complications.

Main Methods:

• Retrospective analysis of 238 patients undergoing total gastrectomy with EEA stapler-assisted esophagojejunostomy.
• Categorization of stapling failures into immediate (intraoperative) and delayed (postoperative) complications.
• Documentation of complication types, severity, and treatment strategies.

Main Results:

• Immediate failures included esophageal muscular disruption (10 cases) and jejunal mucosal disruption (3 cases), all managed surgically.
• Delayed complications occurred in 18 patients: 8 anastomotic leakages (3.4%) and 10 stenoses (4.2%).
• Most leakages were minor; stenoses were primarily membranous or granular, with one requiring surgery after leakage healing. Nine stenoses were successfully treated with dilation.

Conclusions:

• The EEA stapling device is a reliable tool for creating esophagojejunostomy following total gastrectomy.
• Complication rates are low, with most delayed issues manageable non-surgically.
• The technique demonstrates a favorable safety profile for gastric cancer surgery reconstruction.