Intracorporeal circular-stapled anastomosis after totally laparoscopic gastrectomy: A novel, simplest u-shaped parallel purse-string suture technique.

Background: Intracorporeal anastomoses in totally laparoscopic gastrectomy (TLG) remain technical challenges to many surgeons, although the intracorporeal jejunojejunal or gastrojejunal anastomosis is an essential procedure during TLG. Standardized, reproducible and simple circular-stapled anastomosis in open gastrectomy is limited in TLG due to the difficulties of intracorporeal purse-string suture or anvil placement. An optimal procedure for intracorporeal anastomosis in TLG remains to be established.

Methods: Between February 2018 and January 2019, 31 consecutive patients with gastric cancer underwent totally laparoscopic total gastrectomy (TLTG) or totally laparoscopic distal gastrectomy (TLDG) using the novel u-shaped parallel purse-string suture technique along the jejunum for anvil placement. The intracorporeal circular-stapled jejunojejunostomy of Roux-en-Y reconstruction in TLTG and gastrojejunostomy of Billroth II in TLDG were, respectively, performed.

Results: The total mean  ± SD operative time was 214.7 ± 48.6 minutes. The time required for purse-string suture and anvil placement was 2.3 ± 0.5 and 4.4 ± 1.1 minutes, respectively. There were no instances of postoperative jejunojejunal or gastrojejunal anastomosis-related complications observed during the median follow-up period of 5.5 months.

Conclusions: The novel procedure conceptionally and technically changes the conventional circular-shaped purse-string suture into a much simpler way, u-shaped parallel purse-string suture. This could be the simplest published intracorporeal pure-string suture technique.