Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil™) after laparoscopic total gastrectomy
Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil™) after laparoscopic total gastrectomy
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DOI：
10.1007/s00464-009-0461-z
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发表时间：
2009-11-01
影响因子：
3.1
通讯作者：
Park, Young Kyu
中科院分区：
文献类型：
--
作者：
Jeong, Oh;Park, Young Kyu
背景腹腔镜全胃切除术（LTG）由于其重建技术难度更大，因此不如腹腔镜远端胃切除术（LDG）普及。尽管LTG后重建方法的各种修改，但尚未建立最佳程序。作者报告了LTG后新开发的重建技术：使用经口插入钉砧（OrVil（TM）; Covidien，曼斯菲尔德，MA，美国）行食管内环形吻合器食管空肠吻合术。然后使用OrVil（TM）系统将砧座经口插入食管。通过4 cm中线小型剖腹术进行空-空吻合术，准备50 cm Roux-en-Y空肠分支后，将圆形吻合器插入空肠并引入腹腔。通过使用与圆形吻合器连接的手术手套密封剖腹手术伤口牵开器来建立气腹。结果16例患者均无术中并发症，无中转开放手术，无扩大原切口行吻合。平均手术时间和失血量分别为194 min和272 ml。1例患者术后出现腹腔内脓肿。术后X线透视显示所有患者均无吻合口漏或狭窄。术后第3-5天恢复口服流质饮食，术后平均住院时间为11d.Conclusions 16例患者采用我们的技术成功地进行了LTG与Roux-en-Y重建，无吻合口并发症。我们认为，我们的手术是LTG后安全可靠的重建方法，特别适用于肥胖患者，因为传统的体外吻合术通常很困难。
Background Laparoscopic total gastrectomy (LTG) has not become as popular as laparoscopic distal gastrectomy (LDG) because of the more difficult reconstruction technique. Despite various modifications of reconstruction methods after LTG, an optimal procedure has yet to be established. The authors report the newly developed reconstruction technique after LTG: intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil (TM); Covidien, Mansfield, MA, USA).Methods After full mobilization of the abdominal esophagus, the esophagus is transected with an endoscopic linear stapler. The anvil is then transorally inserted into the esophagus by using the OrVil (TM) system. After jejunojejunostomy is performed through a 4-cm midline minilaparotomy, preparing a 50-cm Roux-en-Y jejunal limb, a circular stapler is inserted into the jejunum and introduced into the abdominal cavity. Pneumoperitoneum is established by sealing off the laparotomy wound retractor with a surgical glove attached to the circular stapler. Double-stapling esophagojejunostomy with a circular stapler is performed intracorporeally, and the jejunal stump is closed with an endoscopic linear stapler.Results Of the 16 patients who underwent this operation,, there was no intraoperative complication or conversion to open Surgery, and no patient required an extension of the initial incision for anastomosis. Mean operation time and blood loss were 194 min and 272 ml, respectively. One patient developed an intra-abdominal abscess postoperatively. Postoperative fluorography revealed no anastomosis leakage or stenosis in any of the patients. Patients resumed an oral liquid diet on postoperative day 3-5, and the mean postoperative hospital stay was 11 days.Conclusions We have successfully performed LTG with Roux-en-Y reconstruction using our technique in 16 patients Without any anastomosis complications. We believe that our procedure is a secure and reliable reconstruction method after LTG, which is especially useful in obese patients, in whom conventional extracorporeal anastomosis often is difficult.