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Anastomotic complications after laparoscopic total gastrectomy with esophagojejunostomy constructed by circular stapler (OrVil(TM)) versus linear stapler (overlap method)

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Title: Anastomotic complications after laparoscopic total gastrectomy with esophagojejunostomy constructed by circular stapler (OrVil(TM)) versus linear stapler (overlap method)
Other Titles: Comparative study of esophagojejunostomy
Authors: Kawamura, Hideki Browse this author →KAKEN DB
Ohno, Yosuke Browse this author
Ichikawa, Nobuki Browse this author →KAKEN DB
Yoshida, Tadashi Browse this author →KAKEN DB
Homma, Shigenori Browse this author →KAKEN DB
Takahashi, Masahiro Browse this author
Taketomi, Akinobu Browse this author →KAKEN DB
Keywords: Laparoscopic gastrectomy
Total gastrectomy
Gastric cancer
Esophagojejunostomy
Anastomotic complication
Issue Date: Dec-2017
Publisher: Springer
Journal Title: Surgical endoscopy
Volume: 31
Issue: 12
Start Page: 5175
End Page: 5182
Publisher DOI: 10.1007/s00464-017-5584-z
PMID: 28488177
Abstract: Background: Esophagojejunostomy after laparoscopic total gastrectomy (LTG) is the most technically difficult type of anastomosis; thus, anastomotic complications such as leakage and stenosis sometimes occur. Identification of the safest anastomotic procedure is important for successful LTG. We have performed LTG since 2004 either with a circular stapler using an OrVil(TM) anvil or via the overlap Orringer method with a linear stapler. This retrospective study aimed to determine which method results in a lower incidence of anastomotic complications in patients undergoing LTG. Methods: Data on 188 consecutive patients who underwent LTG between April 2004 and August 2016 were retrospectively reviewed. Patients were divided into those who underwent esophagojejunostomy performed via a circular stapler using an OrVil(TM) anvil (group C, n = 49) or via the overlap method (group L, n = 139). Results: Anastomotic complications occurred in five of 188 esophagojejunostomies (2.7%). They comprised three cases of leakage (1.6%), and two of stenosis (1.1%). There was no significant difference in patient characteristics or hematological variables between groups C and L. There was no significant difference between groups in operation time, blood loss, lymph node dissection, and intraoperative anastomotic problems. The rate of anastomotic complications was significantly lower in group L (0.7%, 1/139) than in group C (8.2%, 4/49; p = 0.005). In particular, anastomotic leakage in group L tended to be lower (0.7% 1/139) than in group C (4.1% 2/49), although this difference was not significant. The rate of anastomotic stenosis in group L was significantly lower (0%, 0/139) than in group C (4.1%, 2/49; p = 0.017). Furthermore multivariate analysis showed anastomotic procedure was an independent factor for anastomotic complication. Conclusions: There were fewer anastomotic complications after overlap esophagojejunostomy than after esophagojejunostomy via the OrVil(TM) procedure, especially regarding anastomotic stenosis. We therefore recommend the overlap technique when performing esophagojejunostomy.
Rights: The final publication is available at link.springer.com
Type: article (author version)
URI: http://hdl.handle.net/2115/72079
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 川村 秀樹

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