Esophagojejunostomy using a circular stapler after laparoscopic total gastrectomy with pouch suture and...

Laparoscopic total gastrectomy (LTG) still poses certain technical challenges today, especially in performing esophagojejunostomy during laparoscopic gastric resection, as this procedure demands high technical expertise and is considered difficult. Currently, digestive tract reconstruction methods after LTG involve two main types of anastomosis: circular stapler anastomosis and linear stapler anastomosis. Circular stapler anastomosis is considered the "gold standard" for esophagojejunostomy in open total gastrectomy. The pouch suture device is used to create a pouch along the distal esophagus, which forms the standard technique for circular stapler-based esophagojejunostomy in open surgery. There is still no consensus on the optimal anastomosis method, and thus, a simple, effective laparoscopic pouch suture device or instrument paired with an appropriate esophagojejunostomy in the small intestine remains to be developed. This retrospective study analyzed 37 patients who underwent laparoscopic total gastrectomy with esophagojejunostomy using a novel laparoscopic pouch suture clamp (Lap-PSC) and multifunctional sealing cap (MSC) at the First People's Hospital of Yancheng from June 2023 to February 2025. The study aimed to achieve a simple intraluminal circular stapler esophagojejunostomy in gastric cancer patients and to present the surgical details and analyze the postoperative outcomes. The average operative time was 272.89 ± 31.04 min, and no tumor was found at the surgical margins in all patients. Three postoperative complications occurred, one of which was an A-grade anastomotic leak, while the other complications were unrelated to the anastomosis. No deaths were reported. During the median follow-up period of 17 months, no anastomotic-related complications were observed. The combined use of Lap-PSC and MSC allows for the safe, simple, and standardized completion of single-anastomosis esophagojejunostomy with a circular stapler in laparoscopic total gastrectomy (LTG).