Preventive procedure for stenosis after esophagojejunostomy using a circular stapler and transorally inserted anvil (OrVil™) following laparoscopic proximal gastrectomy and total gastrectomy involving reduction of anastomotic tension

摘要

Schematic illustration of the steps of intracorporeal esophagojejunostomy in laparoscopic proximal and total gastrectomy. Laparoscopic proximal gastrectomy: a The mesentery supporting the section of the jejunum between 20–30 cm from the ligament of Treitz was dissected along with the jejunum. b The head of the shaft of the CS [DST EEA XL™ shaft (Covidien)] was inserted in the cranial direction through the incised jejunum, 10–15 cm from the oral end of the jejunal stump, and the central rod was introduced from just at the caudal side of the jejunal stump. c The jejunal stump and the head of the shaft were simultaneously inserted into the abdominal cavity, and anastomosis was performed under a good visual field. d Completed reconstruction following laparoscopic proximal gastrectomy. Laparoscopic total gastrectomy: e The mesentery supporting the section of the jejunum between 20–30 cm from the ligament of Treitz was dissected along with the jejunum to harvest the jejunum for anastomosis. f The head of the shaft of the CS was inserted by incising the oral edge of the caudal part of the jejunum of which the mesentery was dissected, and the center rod of the CS was introduced from the jejunum while maintaining its blood flow. g Anastomosis was performed under a good visual field. h Completed reconstruction following laparoscopic total gastrectomy