Efficacy of a linear stapler in entry hole closure during overlap anastomosis in minimally invasive gastrectomy

Overlap anastomosis is widely used in gastrointestinal reconstruction during minimally invasive gastrectomy. The entry hole of the anastomosis is typically closed with hand-sewn sutures because of concerns about stenosis. This study aimed to compare the efficacy of linear stapler (LS) closure with that of hand-sewn closure of the entry hole in overlap anastomosis.

We included 172 patients who underwent overlap anastomosis during laparoscopic or robot-assisted total gastrectomy (TG, Roux-en-Y) or distal gastrectomy (DG, Roux-en-Y/Billroth II) between February 2020 and September 2024. The patients were divided into two groups based on the method of entry hole closure: the suturing group (S group) and the LS group. Surgical outcomes were retrospectively analyzed.

There were no significant differences in patient characteristics or tumor staging between the two groups. TG was performed in 46 and 17 patients in the S and LS groups, respectively, whereas DG was performed in 41 and 68 patients in the S and LS groups, respectively. In TG patients, there was no significant difference in operative time, but the esophageal-jejunal overlap anastomosis time was significantly shorter in the LS group (38.3 vs. 20.5 min, P < 0.001). The incidence of postoperative complications was similar in both groups, and no cases of stenosis were observed in the LS group. In DG patients, the operative time and gastric-jejunal overlap anastomosis time were significantly shorter in the LS group (294 min vs. 253 min, P = 0.002; 28.5 vs. 9.0 min, P < 0.001). The length of postoperative hospital stay was significantly shorter in the LS group (13 vs. 11 days, P = 0.01).

Using an LS to close the entry hole in an overlapping anastomosis during minimally invasive gastrectomy can reduce the anastomosis time and may be a safe option without increasing the risk of stenosis.