Novel double-stapling technique for distal oesophageal resection and oesophago-jejunal anastomosis


COD: 01_2016_1192_2460 Categorie: ,

Sergio Gentilli, Luca Portigliotti, Fabio Davoli, Alberto Roncon, Ottavio Rena, Alberto Oldani

Ann. Ital. Chir., 2016 87: 79-82
Published online 4 December 2015

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AIM: The restoration of the digestive tract by performing an esophago-jejunal anastomosis (EJA) is a crucial step of the
total gastric and distal esophagus surgical resection for esophago-gastric junction (EGJ) cancer. We have already ideated
and tested on a cadaver model an innovative technique which could be useful to minimize the risk of complications
related to the phase of securing the anvil of the circular stapler prior to perform the EJA. This surgical technique was
derived from the well-known “double-stapling Knight and Griffen” one that was described for the rectal resection. We
used the following described technique in 20 patients with EGJ cancer and it is efficient, reliable, safe, easy to learn
and easy to perform.
MATERIALS AND METHODS: From August 2014 to May 2015, 20 patients (14 male and 6 female) underwent surgery
for esophagogastric junction cancer: In all patients a distal esophageal resection and total gastrectomy was performed.
Through the trans-hiatal access, the free margins of the esophageal stump were suspended and the anvil of a circular
stapler on a new dedicated and registered support bar was inserted into the lumen. Subsequently, the linear suturing
stapler is closed over the bar and then fired to suture the distal stump of the esophagus; after the confirmation of a negative
margin, the bar is retracted and the push-rod of the anvil is pulled out through the linear suture. Finally, the
anastomosis is performed with the classic technique by using a circular stapler.
RESULTS: No postoperative mortality occurred; postoperative course has been uneventful for 18 patients. One patient developed
anastomotic fistula that has been treated conservatively with endoscopic prothesis, removed after 20 days. One patient
developed in 3 POD myocardial infarction Mean Hospital stay has been 14 days (range 7-20 days).
CONCLUSIONS: The aim of our new procedure is the insertion the anvil of a common circular stapler without handsewn
securing; this is to reduce the technical difficulties related to the hand-sewn securing into a deep and narrow
anatomic location, typical of the trans-hiatal approach.