A simple technique for performing laparoscopic purse-string suturing during circular stapling anastomosis

Surg Today. 2005;35(10):896-9. doi: 10.1007/s00595-005-3030-7.

Abstract

An esophagojejunostomy using a circular stapler requires the fixing of an anvil at the esophageal stump. When this placement procedure is laparoscopically performed, purse-string suturing is difficult, and there is a risk of loosening when a conventional needle driver is used. We herein present a simple but effective technique for performing laparoscopic purse-string suturing of the esophageal stump using a semiautomatic suturing device called the Endostitch. Gastrointestinal anvil placement was laparoscopically performed for 10 patients who underwent an esophagojejunostomy following a total gastrectomy. After the lumen of the esophagus was expanded using bowel forceps, the Endostitch was used to place approximately 12 encircling purse-string sutures. An anvil was positioned with support of the esophageal wall at three points with forceps. The Endostitch was used for the ligation with a sufficient degree of tension applied by extracorporeally pulling the sutures through the abdominal wall. The time for placement of the anvil averaged approximately 8 min. The ring formation following anastomosis was favorable in all patients. As a result, we consider our technique to be simple but very effective.

Publication types

  • Comparative Study

MeSH terms

  • Anastomosis, Surgical / methods
  • Esophagus / surgery*
  • Gastrectomy / methods
  • Gastroscopy / methods*
  • Humans
  • Jejunum / surgery*
  • Sensitivity and Specificity
  • Surgical Stapling
  • Suture Techniques*