37. The new technique to insert anvil into esophagus for anastomosis during laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric cancer

Objective: To explore the clinical practical value of the new anvil pull-through inserting method for esophagogastrostomy or esophagojejunostomy during laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric 123 cancer.
Methods: The clinical data of 21 cases enrolled in our centre during March 2010 and Feb 2011 are retrospectively analyzed. All the cases were underwent laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric cancer. In these cases the new anvil pull-through inserting method for esophagogastrostomy or esophagojejunostomy was applied. Briefly, after pero-gastric lymphadenectomy and mobilization of esophagus, a minimal incision was made on the side 3 cm above the tumor level, and the anvil with drawn wire attached was inserting into the esophagus. The endo-cutter was applied to cut the esophagus adjacent to the minimal incision with the drawn wire untouched. Then the allocation pole was pulled out by the drawn wire for laparoscopic anastomosis.
Results: All the 21 cases were accomplished under laparoscopic operation, in which 15 cases were radical total gastrectomy with esophagojejunostomy and 6 cases were radical proximal gastrectomy with esophagogastrostomy. The mean operation time, volume of blood loss, time to gastrointestinal function recovery and duration of postoperative hospital stay were 256.8±38.2 min, 118.5±32.3 mL, 3.7±0.8 d, 7.5±2.6 d. No postoperative anastomotic leakage was detected. Twenty-one patients were followed up for 6-17 months with a mean time of 10.7±3.5 months, and no tumor recurrence or metastasis occurred.
Conclusions: This new anvil pull-through inserting method is safe and sound, simple to manipulate and easy to learn. The method also decreases the laparoscopic reconstruction difficulty and reduces the operational time. This method may provide an new choice for laparoscopic esophagogastrostomy or esophagojejunostomy.