Hiroshi Makino, MD1, Hiroshi Yoshida, MD1, Hiroshi Maruyama, MD1, Tadashi Yokoyama, MD1, Atsushi Hirakata, MD1, Jyunji Ueda, MD1, Yuta Kikuchi1, Koji Ueda, MD1, Masafumi Yoshioka, MD1, Makoto Kusakabe1, Toshiyuki Irie, MD1, Nobuyuki Sakurazawa2, Masao Miyashita, MD2, Eiji Uchida, MD3. 1Department of Surgery, Nippon Medical School, Tama-Nagayama Hospital, 2Department of Surgery, Nippon Medical School, Chiba-Hokusoh Hospital, 3Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
Background: It is also difficult to anastomose using circular stapler in the narrow neck field. To overcome the problem we modified circular stapling for anastomosis. Gastric juice reflux is frequently observed at the esophago-gastric anastomosis. We develop and report trapezoidal tunnel method to reduce the incidence reflux.
One hundred thirteen cases (27 in left lateral and 93 in prone position), with esophageal carcinomas underwent VATS-E, respectively. Esophago-gastric anastomosis is performed for 80 cases by modified circular stapling and 3 cases by trapezoidal tunnel method.
At first the patients are fixed at semi-prone position and esophagectomy is performed in prone position that can be set by rotating and 5 ports are used at the intercostal space (ICS). Esophagectomy and the L.N. dissection are performed with pneumothorax by maintaining CO2 insufflation.
Esophago-gastric anastomosis is performed as following,
i) Trapezoidal Tunnel Method
Sero-muscular layer of anterior wall in the near top of gastric conduit is peeled from submucosal layer after parallel horizontal incision of sero-muscular layer, and then trapezoidal tunnel of sero-muscular layer is created. The edge of the proximal esophagus is drawn into the tunnel and esophago-gastric submucosa anastomosis is performed. To wrap anastomosis distal side of parallel line is closed.
ii) modified circular stapling
At first the circular stapler is introduced into the gastric conduit and joined to an anvil, and close a little. And then a joined anvil is placed into the proximal esophagus and secured by means of a pursestring suture. The gastric conduit opening is closed by a linear stapler.
1. The rate of anastomotic leak by modified circular stapling was 4.0%.
2. Both anastomotic leakage and reflux are not observed in 3 cases anastomosis by trapezoidal tunnel method.
1. Our both anastomotic technique is safe.
2. Gastric juice reflux at the anastomosis might be controllable by trapezoidal tunnel method.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86888
Program Number: P465
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster