![]() Technique and outcomes of laparoscopic-combined linear stapler and hand-sutured side-to-side esophagojejunostomy with Roux-en-Y reconstruction as a treatment modality in patients undergoing proximal gastrectomy for benign and malignant disease of the gastroesophageal junction. Use of boabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surgical adhesive increases burst pressure and seals leaks in stapled gastrojejunostomy. Nandakumar G, Richards BG, Trencheva K, et al. Prospectve randomized trial of prospective randomized trial of heated humidified versus cold dry carbon dioxide insufflation during laparoscopic gastric bypass. Technique of Roux-en-Y reconstruction using overlap method after laparoscopic total gastrectomy for gastric cancer: 100 consecutively successful cases. Kitagami H, Morimoto M, Nakamura K, et al. ![]() Improved the side-to-side stapled anastomosis: comparison of staples for robust crotch formation. Weak points of a stapled side-to-side anastomosis. Different characteristics of circular staplers make the different in anastomotic tensile strength. Giaccaglia V, Antonelli MS, Franceschilli L, et al. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience. With our experiment, the mechanism by which leaks occur at the crotch has become clear, giving evidence for the optimal reinforcement method for stapled intestinal anastomoses. The efficacy of various crotch reinforcement methods both experimentally and clinically has thus far been in doubt. In the group reinforced with nylon sutures, the crotch of the anastomosis expanded, and the intestine split, leading to a dehiscence and leak. In the group using Neoveil® there was no obvious change in the Neoveil® itself with increases in pressure. A leak occurred when the split reached the center of the staple line. Observing from within the intestinal lumen, as the pressure increased, the intestine split along the length of the stapled anastomosis. When reinforced with nylon suture, resistance to leak was recognized only in anastomoses with suture reinforcement from within the lumen. Neoveil® significantly increased the burst pressure (41.4 ± 3.6 vs. In all experimental groups, the leak was observed not only on the serosal surface but also from within the lumen. We observed a significant difference in the resistance of the crotch to leak between the two types of reinforcement. Using an endoscope inserted into the intestinal lumen, we observed the burst process. ![]() Comparison was made in five groups, with different staple heights, presence of Neoveil® (Gunze, Japan), with or without crotch buttressed with nylon. We analyzed the burst pressures of anastomoses. MethodsĪ side-to-side anastomosis was performed between two intestinal specimens using a linear stapler. However, countermeasures to prevent leaks from the crotch have not proven to be sufficient. The vulnerability of the crotch on a side-to-side anastomosis to leak has been widely recognized. ![]()
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