Intracorporeal end-to-end esophagojejunostomy using a circular stapler

Introduction

Various methods exist for esophagojejunostomy, with the use of a circular stapler being a common choice in open gastrectomy. On the other hand, linear staplers have become preferably used in laparoscopic/robotic gastrectomy [1]. Although the use of linear staplers has the advantages of better view and easier manipulation, it has the drawback of unnecessary esophageal/mediastinal dissection which possibly reduces the function of the lower esophageal sphincter [2]. When we adopt the standard end-to-side anastomosis with a circular stapler to overcome these issues in laparoscopic/robotic gastrectomy, it is associated with poor tissue visualization and the potential risk of tissue involvement. We have developed an innovative intracorporeal end-to-end esophagojejunostomy procedure in order to address these limitations.

Technique

Firstly, following gastric resection, we intracorporeally inserted and secured the anvil head to the esophageal stump. Subsequently, we performed a 4-cm mini-laparotomy at the umbilical site. Through this mini-laparotomy incision, we created a jejunal limb and made an entry hole longitudinally 10 cm from the jejunal stump. Then, we inserted the circular stapler through the entry hole into the jejunal limb, exposed the rod of the circular stapler at the end of the jejunal stump and placed a cap on the tip of the rod. The circular stapler was secured to the jejunal limb using a rubber band to prevent it from dislodging as we carefully guided it into the abdominal cavity.

Afterward, docking and firing were performed intracorporeally, and the entry hole of the jejunal limb was closed transversely using the linear stapler.

Results

From April 2021 to April 2023, 12 patients underwent end-to-end esophagojejunostomy. The median age of the patients was 76 (IQR 61–87) years, with an equal sex distribution. A total of 10 patients underwent total gastrectomy, whereas 2 underwent proximal gastrectomy with double-tract reconstruction. A 23- and 25-mm stapler was used in nine and three patients, respectively. No anastomotic complications such as leakage, stenosis, or bleeding were observed. Furthermore, no complications related to the jejunum limb entry hole were detected.

Conclusion

Intracorporeal end-to-end esophagojejunostomy using a circular stapler yielded acceptable outcomes and could be a choice for esophagojejunostomy procedure in laparoscopic/robotic gastrectomy.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

DY: Acquisition, analysis, and interpretation of data, drafting, revision. HH: Proofreading, editing, revision, and advising. SY: Proofreading, editing, revision, and advising. SK: Proofreading, editing, revision, and supervision. All authors have approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Data availability

All data included in this report are available upon reasonable request from the corresponding author.

Declarations

Conflict of interest

All authors have no conflicts of interest or financial ties to disclose.

Ethical approval

All the studies were conducted following the ethics of the Declaration of Helsinki and approved by the ethics committee of the Japanese Red Cross Osaka Hospital (J-0526). The requirements to obtain individual patient consent was waived because of the retrospective nature of the study.

Informed consent

Written informed consent was obtained from the patient for publication of this video article and any accompanying images.