J Korean Surg Soc.
2000 Jan;58(1):67-72.
Pitfalls of Gastrojejunostomy Using Linear Stapler
- Affiliations
-
- 1Gastric Division, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
Abstract
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BACKGROUND & PURPOSE: The most popular anastomotic method for a Billroth-II gastrectomy is an
'Albert-Lembert' type two-layer gastro jejunostomy (G-Jstomy) which seems more secure than a
'Gambee' type single-layer anastomosis which provides better mucosal apposition. Since 1995, I have
used linear-type staplers during a Billroth-II gastrectomy and palliative bypass surgery for gastric cancer
patients to make the G-Jstomy more convenient. There use shortened the operating time and made the
gastrojejunostomy easier. I reviewed four years of stapling experience to prove the merits of a stapled
G-Jstomy so as to encourage the surgeons who hesitate to do so for fear of complications.
METHODS
1,049 Billroth-II gastrectomies and 133 palliative gastrojejunostomies were carried out from
January 1995 to December 1998 at Asan Medical Center. A linear stapler was used in 319 of the above
procedures.
RESULTS
A linear stapler with two rows of staples was used without any anastomotic leakage or
hemorrhage. However, I experienced several efferent jejunal loop obstructions due to adhesion around
the anastomosis at the beginning of the trial. All the adhesions occurred at the suture materials of stapler
port which was closed manually. No more obstructions were observed after modifying the location of
and the closing method for the stapler port. Nowadays, conventional manual G-Jstomy has been safely
replaced with a stapled G-Jstomy.
CONCLUSION
This report of a clinical trial offers a safe technique for a stapled G-Jstomy by solving
the pitfalls.