Reducing anastomotic complications with endoscopy in laparoscopic total gastrectomy

Early postoperative anastomosis-related complications are frequently associated with technical defects during the anastomotic procedure. Few studies focused on intraoperative anastomotic complications in esophagojejunostomy with circular stapler.

To explore whether endoscopic examination could reduce the occurrence of early postoperative anastomotic complications.

Clinical data from 160 patients with gastric cancer who underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler at Nanchong Central Hospital from January 2020 to December 2023 were retrospectively analyzed. Based on whether intraoperative endoscopic examination (IEE) was performed, patients were divided into the IEE group and the non-IEE (NIEE) group.

All patients successfully underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler. In the IEE group, 7 (8.8%) patients were found to have anastomotic defects: 3 (3.8%) air leaks, 2 (2.5%) bleeding, 1 (1.3%) stricture and 1 (1.3%) full-thickness tearing. Three patients with anastomotic discontinuities were subsequently treated with additional suturing. One anastomotic bleeding was managed with laparoscopic suturing, and another was treated with endoscopic clips. One patient had anastomotic stricture, which was corrected intraoperatively. One patient experienced full-thickness tearing caused by the circular stapler, necessitating a redo anastomosis. These anastomotic defects were repaired intraoperatively, and no postoperative anastomotic complications occurred. 6 (7.5%) patients with postoperative anastomotic complications were observed in the NIEE group. The NIEE group had a significantly higher incidence of postoperative anastomosis-related complications compared to the IEE group (7.5% vs 0%; P = 0.029).

Routine IEE significantly reduces early anastomotic complications by enabling immediate detection and repair of technical defects in esophagojejunostomy with circular stapler.