Improved anastomotic technique for esophagojejunal anastomosis using circular stapler

Area of Science:

• Gastrointestinal surgery
• Surgical oncology
• Surgical innovation

Background:

• Roux-en-Y reconstruction with esophagojejunal anastomosis is standard after total gastrectomy.
• Anastomotic leakage is a significant complication, often attributed to esophageal fragility.
• Current techniques may cause esophageal trauma, increasing leakage risk.

Purpose of the Study:

• To introduce and evaluate an atraumatic, innovative technique for esophagojejunostomy.
• To minimize esophageal trauma during gastrointestinal reconstruction.
• To potentially reduce anastomotic leakage rates after total gastrectomy.

Main Methods:

• Prospective study of 14 gastric cancer patients undergoing open total gastrectomy.
• Novel esophagojejunal anastomosis using a circular stapler device.
• Placement of stay sutures to maximize esophageal stump diameter, avoiding forceps and tears.

Main Results:

• No esophageal tears or technical issues observed in 14 patients.
• Overall postoperative complications occurred in 42.9% of patients, all managed conservatively.
• One case of anastomotic leakage (Clavien-Dindo-II) was successfully treated conservatively.

Conclusions:

• The new atraumatic anastomosis technique effectively prevents esophageal wall tears and trauma.
• This innovative method enhances the safety of esophagojejunostomy.
• The technique shows potential for preventing anastomotic leakage and other complications.