A modified stapling technique for esophagojejunostomy after total or proximal gastrectomy

Area of Science:

• Gastrointestinal surgery
• Surgical techniques
• Surgical oncology

Background:

• Stapling devices in digestive tract anastomoses reduce leakage but increase stricture risk.
• Esophagojejunostomy is a common procedure after gastrectomy.
• Anastomotic strictures and dysphagia are significant complications.

Purpose of the Study:

• To evaluate a modified end-to-end anastomosis stapling technique for esophagojejunostomy.
• To compare the incidence and severity of dysphagia between the modified and conventional techniques.
• To assess the impact of the modified technique on anastomotic diameter.

Main Methods:

• A modified stapling technique involving esophageal mucosal and jejunal layers with hand-sewn sutures was used in 21 patients.
• A conventional stapled anastomosis was performed in 17 patients.
• Dysphagia severity and anastomosis size (via X-ray) were compared between groups.

Main Results:

• The modified technique showed significantly better results for dysphagia severity (p = 0.0025).
• Patients in the modified group experienced predominantly mild dysphagia, unlike moderate to severe in the conventional group.
• The modified group's anastomosis inner diameter (12.1 ± 2.5 mm) was significantly larger than the conventional group's (10.0 ± 1.8 mm; p = 0.009).

Conclusions:

• The modified stapling technique minimizes the risk of anastomotic stricture.
• This technique effectively reduces the feeling of dysphagia after esophagojejunostomy.
• The improved outcomes suggest the modified technique is a valuable advancement in gastrectomy surgery.