Reducing anastomotic complications with endoscopy in laparoscopic total gastrectomy

Area of Science:

• Gastrointestinal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Anastomosis-related complications after esophagojejunostomy are often linked to technical issues.
• Few studies have investigated intraoperative complications specific to circular stapler esophagojejunostomy.

Purpose of the Study:

• To determine if intraoperative endoscopic examination (IEE) can decrease early postoperative anastomotic complications.
• To evaluate the efficacy of IEE in identifying and managing technical defects during esophagojejunostomy.

Main Methods:

• Retrospective analysis of 160 gastric cancer patients undergoing laparoscopic total gastrectomy with circular stapler esophagojejunostomy.
• Patients were stratified into an IEE group and a non-IEE (NIEE) group based on intraoperative examination.

Main Results:

• The IEE group showed no postoperative anastomotic complications (0%), while the NIEE group had a 7.5% complication rate (P = 0.029).
• Intraoperative endoscopic examination identified various defects including air leaks, bleeding, stricture, and tearing, all successfully managed during surgery.
• The incidence of early postoperative anastomosis-related complications was significantly lower in the IEE group compared to the NIEE group.

Conclusions:

• Routine intraoperative endoscopic examination is effective in reducing early anastomotic complications following circular stapler esophagojejunostomy.
• Immediate detection and repair of technical defects via IEE improve surgical safety and patient outcomes.