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Intracorporeal esophagojejunostomy using a linear stapler in laparoscopic total gastrectomy: comparison with circular stapling technique

 Sejin Lee  ;  Harim Lee  ;  Jeong Ho Song  ;  Seohee Choi  ;  Minah Cho  ;  Taeil Son  ;  Hyoung-Il Kim  ;  Woo Jin Hyung 
 BMC SURGERY, Vol.20(1) : 100, 2020-05 
Journal Title
Issue Date
Circular stapler ; Esophagojejunostomy ; Laparoscopic total gastrectomy ; Linear stapler ; Stenosis
Background: Laparoscopic total gastrectomy for gastric cancer is feasible but less commonly performed compared to laparoscopic distal gastrectomy due to technical difficulties such as reconstruction. There is no standard esophagojejunal anastomosis technique in laparoscopic total gastrectomy due to a lack of evidence. Methods: We retrospectively analyzed data from 213 patients with gastric cancer who underwent laparoscopic total gastrectomy from October 2012 to December 2016. Of these, 109 and 104 patients underwent esophagojejunostomy with linear and circular stapling, respectively. We compared short-term postoperative outcomes, including surgical complications and anastomosis costs between both groups. Results: The mean operation time in the linear stapler group was longer than the circular stapler group (Linear stapler, 235.3 ± 57.9 vs. Circular stapler, 217.1 ± 55.8 min; P = 0.021); however, D2 lymph node dissection was performed more in the linear stapler group (Linear stapler, 36.7% vs. Circular stapler, 23.1%; P = 0.030). There were two anastomosis leakages in each group (Linear stapler, 1.8% vs. Circular stapler, 1.9%; P > 0.999). Anastomosis stenosis only occurred in the circular stapler group (Linear stapler, 0% vs. Circular stapler, 7.7%; P = 0.003). Although the linear stapling technique used more stapler cartridges (Linear stapler, 7.6 ± 1.1 vs. Circular stapler, 4.8 ± 0.9; P < 0.001), costs related to anastomosis were lower in the linear stapler group (Linear stapler, 1,904,679 ± 342,116 vs. Circular stapler, 2,246,150 ± 427,136KRW; P < 0.001). Conclusions: Esophagojejunostomy with the linear stapling technique reduces anastomosis stenosis in laparoscopic total gastrectomy. It can be recommended as a safe and more cost-effective method for esophagojejunal anastomosis.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyoung Il(김형일) ORCID logo https://orcid.org/0000-0002-6134-4523
Son, Tae Il(손태일) ORCID logo https://orcid.org/0000-0002-0327-5224
Song, Jeong Ho(송정호)
Lee, Sejin(이세진)
Cho, Minah(조민아) ORCID logo https://orcid.org/0000-0003-3011-5813
Choi, Seo Hee(최서희)
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
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