Comparison of postoperative conditions between esophagogastrostomy with the double-flap technique and that with a circular stapler in laparoscopic proximal gastrectomy

2017 ◽  
Author(s):  
Masato Hayashi
Keyword(s):  
Proximal Gastrectomy ◽  
Circular Stapler ◽  
Flap Technique ◽  
Laparoscopic Proximal Gastrectomy

scholarly journals The feasibility of vagus nerve preservation and double-flap technique in laparoscopic proximal gastrectomy

2021 ◽  
Author(s):  
Ke-kang SUN ◽  
Zhen WANG ◽  
Wei PENG ◽  
Ming CHENG ◽  
zheng-rong CHEN ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Vagus Nerve ◽  
Proximal Gastrectomy ◽  
Gallbladder Contraction ◽  
Conversion To Open Surgery ◽  
Nerve Preservation ◽  
Flap Technique ◽  
Number Of Patients ◽  
Laparoscopic Proximal Gastrectomy

Background: Laparoscopic proximal gastrectomy with an anti-reflux procedure, as a function-preserving surgery, has been a common treatment strategy for proximal early gastric cancer. This study aimed to develop a new surgical technique for these patients. Methods: Laparoscopic proximal gastrectomy with vagus nerve preservation and double-flap technique was performed in patients who could retain two-thirds of the stomach. The hepatic branches and the celiac branches were both preserved. A seromuscular double-flap was created through the auxiliary incision, and the anastomosis was performed under laparoscopy. The detailed surgical procedure and preliminary results were presented. Results: Six patients underwent this procedure with no conversion to open surgery. No intraoperative and postoperative complications occurred during the perioperative period. No patients showed diarrhea and appetite loss, and body weight regained preoperative level 6 month later. No food residue and reflux esophagitis were observed via endoscopic examination. Gallbladder contraction was observed in all the patients by ultrasonography after high-fat diet. Conclusion: Although long-term follow up and a larger number of patients are required to evaluate the functional outcomes, this new technique provides a minimally invasive surgical option for proximal early gastric cancer, especially in the cardiac area.

scholarly journals Preventive Procedure for Stenosis After Esophagojejunostomy Using A Circular Stapler and Transorally Inserted Anvil (OrVilTM) Following Laparoscopic Proximal Gastrectomy and Total Gastrectomy Involving Reduction of Anastomotic Tension

2020 ◽  
Author(s):  
Eiji Nomura ◽  
Hajime Kayano ◽  
Takatoshi Seki ◽  
Rin Abe ◽  
Hisamichi Yoshii ◽  
...  
Keyword(s):  
Total Gastrectomy ◽  
Early Phase ◽  
Proximal Gastrectomy ◽  
Circular Stapler ◽  
Rubber Band ◽  
Anastomotic Stenosis ◽  
Anastomotic Site ◽  
Laparoscopic Proximal Gastrectomy ◽  
Later Phase ◽  
Circular Staplers

Abstract Background: Recently, due to increasing reports of stenosis after esophagojejunostomy created using circular staplers and a transorally inserted anvil (OrVilTM) following laparoscopic proximal gastrectomy (LPG) and total gastrectomy (LTG), linear staplers are being used instead. We investigated our preventive procedure for esophagojejunostomy stenosis performed using circular staplers.Methods Since the anastomotic stenosis is considered to be mainly caused by tension in the esophageal and jejunal stumps at the anastomotic site, we have been performing procedures to relieve this tension, by cutting off the rubber band and pushing the shaft of the circular stapler toward the esophageal side, since July 2015. We retrospectively compared the incidence of anastomotic stenosis in cases of LPG and LTG performed before July 2015 (early phase, 30 cases) versus those performed after this period (later phase, 22 cases).Results Comparison of the incidence of anastomotic stenosis according to the type of surgery, LPG or LTG, and between the two time periods versus all cases, indicated a significantly lower incidence in the later phase than in the early phase (4.5% vs. 26.7%, p<0.05), especially for LPG (0% vs. 38.5%, p<0.05).Conclusions It is possible to use a circular stapler during laparoscopic esophagojejunostomy, as with open surgery, if steps to reduce tension on the anastomotic site are undertaken. These procedures will contribute to the spread of safe and simple laparoscopic anastomotic techniques.

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