Linear or hemi-double stapling technique esophagojejunostomy after laparoscopic total gastrectomy

Bandar Ali, MD, Kyo Young Song, PhD, Jin Won Lee, MD, Cho Park, PhD. Seoul St. Mary’s hospital, The catholic university of Korea

AIM:

To investigate the feasibility, advantages and disadvantages of two novel types of esophagojejunostomy after laparoscopic total gastrectomy in gastric cancer patients either by linear or hemi-double stapling technique

METHODS:

This was a comparison retrospective study of laparoscopy-assisted radical total gastrectomy for confirmed histopathologically cases of gastric cancer between January 2010 and December 2014. The data collected from two hospitals. 1st Patients Group from Seoul Incheon St. Mary’s hospital who underwent esophagojejunostomy using a Linear Cutter (blue cartilage; Ethicon Endo-Surgery, Cincinnati, Ohio) and they were 94 patients. While 2nd patients Group data collected from Seoul St. Mary’s hospital that underwent esophagojejunostomy using the hemi-double stapling technique (HDST) with anvil head and they were 58 patients. Both types of esophagojejunostomy were performed under Laparoscopy and Patients’ baseline characteristics, preoperative characteristics, perioperative characteristics, short-term postoperative outcomes and complications were compared between the two groups. The primary endpoint was evaluation of the surgical outcome of these two types of reconstruction. In addition, complications associated with both techniques were assessed and compared.

RESULTS:

Laparoscopic total gastrectomy and esophagojejunostomy were successfully performed in 88 (93.61%) patients and conversion needed in 6 (6.38%) patients in the linear group while all 58 (100%) patients in hemi-double stapling without conversion to laparotomy. There were significant differences in the patients between the two groups linear vs. circular in clinical ASA 1, 2 grade (P= 0.000), pathological stage (P=0.002), extent of lymph node dissection D1+b, D2 (P=0.000, P=0.000), combined organ resection (P=0.000), operative time (280 ± 84.58 min vs. 199.5 ± 37.06 min) P=0.000, Intraoperative blood loss (197.03±244ml vs 81.03±44.7 ml) P=0.03, A-loop obstruction (P=0.03), 1st flatus day (3.08±0.07 vs. 3.34±0.60) P=0.02, 1st oral diet day (4.08 ±2.63 vs. 5.22±3.21) P=0.03, respectively. While age (59.44±11.6 vs. 57.72±11.81) P=0.82, BMI (23.41±2.9 vs. 23.7±2.6) P=0.62, ASA3 (P=0.48), number of retrieved lymph node (47.88±17.27 vs. 44.17±18.40) P=1.2, post op hospital stay (12.06±10.11 vs. 12.38±13.61) P=0.25, D1 lymph node dissection(P=0.62), D1+a (P=1.0), open conversion (P=0.15), proximal margin (3.8±1.2cm vs. 2.7±0.9cm) P=0.60, distal margin (11.9±3.6cm vs. 10.0±2.6cm) P=0.35, EJ leak (P=0.10), EJ stenosis (P=0.52), EJ fistula (P=0.37), ileus (P=0.6), pneumonia (P=1.0), pleural effusion (P=1.0), post op bleeding (P=1.00), pancreatitis (P=1.00), intra-abdominal fluid collection (P=1.00), wound infection (P=0.63) and mortality (P=0.5) were similar between the two groups linear vs. circular respectively

CONCLUSION: hemi-double stapling technique with anvil head insertion was seems to be faster and easier using in compared with linear stapler technique to perform esophagojejunostomy.

 

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