A Bidirectional Barbed Suture Technique for Secure Entry-hole Closure in Robotic Overlap Esophagojejunostomy: Initial...

Although minimally invasive total and proximal gastrectomy have been increasingly adopted for gastric cancer, anastomotic complications, particularly at the esophagojejunal anastomosis, remain more frequent than after distal gastrectomy. Anastomotic leakage or stenosis can delay postoperative recovery and the initiation of adjuvant chemotherapy, thereby potentially affecting oncologic outcomes. Reliable entry-hole closure during overlap esophagojejunostomy remains technically challenging, especially when luminal diameter mismatch exists between the esophagus and jejunum.

We describe an entry-hole closure technique using a bidirectional barbed suture during robotic overlap esophagojejunostomy. Ten consecutive patients undergoing robotic gastrectomy for gastric cancer (five total gastrectomies with Roux-en-Y reconstruction and five proximal gastrectomies with double-tract reconstruction) were included. Following stapled overlap anastomosis, the entry hole was closed intracorporeally using a STRATAFIX^Ⓡ Spiral PDS Plus^Ⓡ bidirectional barbed suture. Suturing was initiated at the midpoint of the entry hole and proceeded continuously toward both the distal and proximal ends, allowing tension adjustment and full-thickness layer capture without the need for terminal knot fixation.

Entry-hole closure was successfully completed in all patients without conversion. The mean closure time was 15.6 ± 2.3 minutes. No patients experienced anastomotic leakage, stenosis, or other anastomosis-related complications during the postoperative course.

This technique appears technically feasible and safe in this initial experience and may facilitate secure entry-hole closure during robotic overlap esophagojejunostomy.