Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVilâ„¢) after laparoscopic total gastrectomy

Oh Jeong; Young Kyu Park
November 2009
Surgical Endoscopy;Nov2009, Vol. 23 Issue 11, p2624
Academic Journal
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™; Covidien, Mansfield, MA, USA). 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™ 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. 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. 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.


Related Articles

  • LATG with Extracorporeal Esophagojejunostomy: Is This Minimal Invasive Surgery for Gastric Cancer? Sang-Gi Kim; Young-Joon Lee; Woo-Song Ha; Eun-Jung Jung; Young-Tae Ju; Chi-Young Jeong; Soon-Chan Hong; Sang-Kyung Choi; Soon-Tae Park; Kyungsoo Bae // Journal of Laparoendoscopic & Advanced Surgical Techniques;Aug2008, Vol. 18 Issue 4, p572 

    Background: This retrospective study determined whether extracorporeal esophagojejunostomy after laparoscopy-assisted total gastrectomy (LATG) for gastric cancer can be considered minimally invasive surgery, compared to the conventional open total gastrectomy (OTG). Patients and Methods: This...

  • Evaluation of the safety and efficacy of esophagojejunostomy after totally laparoscopic total gastrectomy using a trans-orally inserted anvil: a single-center comparative study. Ito, Hiroaki; Inoue, Haruhiro; Odaka, Noriko; Satodate, Hitoshi; Onimaru, Manabu; Ikeda, Haruo; Takayanagi, Daisuke; Nakahara, Kenta; Kudo, Shin-ei // Surgical Endoscopy;Jun2014, Vol. 28 Issue 6, p1929 

    Background: Although laparoscopic surgery is frequently performed for the treatment of gastric cancer, laparoscopic total gastrectomy is not widely performed because of its technical difficulty. Since December 2007 we have performed esophagojejunostomy after totally laparoscopic total...

  • Laparoscopic Resection of Esophageal Stricture with Transgastric Stapled Anastomosis in a Child with AIDS. Sidler, Daniel; Salzmann, Gian M.; Juzi, Jonathan T.; Moore, Sam W. // Journal of Laparoendoscopic & Advanced Surgical Techniques;Jun2006, Vol. 16 Issue 3, p331 

    A tight stricture in the lower esophageal stricture in a child poses significant surgical challenges. We report the first case of a laparoscopically assisted resection of a distal esophageal stricture in a 2-year-old girl with clinical AIDS (CDC stage 3). The patient presented with dysphagia,...

  • Safety of intracorporeal circular stapling esophagojejunostomy using trans-orally inserted anvil (OrVilâ„¢) following laparoscopic total or proximal gastrectomy - comparison with extracorporeal anastomosis. Yoon Ju Jung; Dong Jin Kim; Jun Hyun Lee; Wook Kim // World Journal of Surgical Oncology;2013, Vol. 11 Issue 1, p1 

    Background: There have been several attempts to develop a unique and easier way to perform esophagojejunostomy during laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy. The OrVilâ„¢ system (Covidien, Mansfield, MA, USA) is one of those methods, but its...

  • Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy. Zuiki, Toru; Hosoya, Yoshinori; Kaneda, Yuji; Kurashina, Kentaro; Saito, Shin; Ui, Takashi; Haruta, Hidenori; Hyodo, Masanobu; Sata, Naohiro; Lefor, Alan; Yasuda, Yoshikazu // Surgical Endoscopy;Oct2013, Vol. 27 Issue 10, p3683 

    Background: The double-stapling technique (DST) for esophagojejunostomy using the transorally inserted anvil (OrVil; Covidien Japan, Tokyo, Japan) is one of the reconstruction methods used after laparoscopy-assisted total gastrectomy (LATG). This technique has potential advantages in terms of...

  • Laparoskopia w wybranych chorobach przewodu pokarmowego. Tarnowski, Wiesław; Grous, Aleksander // Gastroenterologia Polska / Gastroenterology;2009, Vol. 16 Issue 2, p177 

    Development of the laparoscopic technique, new tools and facilities for cutting tissues and homeostasis have resulted in possible safe performance of most operations by means of that technique. The collected data let to recommend laparoscopic operations being convinced of satisfactory results...

  • A modified method of laparoscopic side-to-side esophagojejunal anastomosis: report of 14 cases. Wang Ziqiang; Cai ZhiMin; Chen Jun; Lei Xiao; Luo Huaxing; Yu PeiWu // Surgical Endoscopy;Sep2008, Vol. 22 Issue 9, p2091 

    Alimentary tract reconstruction after laparoscopic total gastrectomy is a technical challenge. Although feasible, reconstruction through a small incision has several drawbacks. The authors therefore report a modified method of laparoscopic side-to-side esophagojejunal anastomosis developed at...

  • Clinical Application of Modified Double Tracks Anastomosis in Proximal Gastrectomy. QUN ZHAO; YONG LI; WEIJIA GUO; ZHIDONG ZHANG; ZHIXUE MA; ZHIKAI JIAO // American Surgeon;Dec2011, Vol. 77 Issue 12, p1593 

    We compared the outcome of two surgical alimentary canal reconstruction methods after proximal gastrectomy. Three hundred ninety-six patients who underwent a radical proximal gastrectomy were randomized into two groups. Group Awas treated withmodified double tracks anastomosis, and Group B was...

  • Comparative study on three types of alimentary reconstruction after total gastrectomy. Hong-Bo Wei; Bo Wei; Zong-Heng Zheng; Feng Zheng; Wan-Shou Qiu; Wei-Ping Guo; Tian-Bao Wang; Jie Xu; Tu-Feng Chen; Wei, Hong-Bo; Wei, Bo; Zheng, Zong-Heng; Zheng, Feng; Qiu, Wan-Shou; Guo, Wei-Ping; Wang, Tian-Bao; Xu, Jie; Chen, Tu-Feng // Journal of Gastrointestinal Surgery;Aug2008, Vol. 12 Issue 8, p1376 

    Background: More than 70 alimentary reconstruction procedures after total gastrectomy have been proposed to reduce the postoperative syndromes such as dumping syndrome, reflux esophagitis, and malnutrition. However, the optimal alimentary reconstruction method is still a matter of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics