Application of bidirectional sutures in total laparoscopic radical total gastrectomy with esophagogastric overlap anastomosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Yingxin ¹ , YANG Xinxi ^1,2 , GUO Pengsen ¹ , NIE Pan ¹ ,  LIU Yanjun ^1,2

1. Section for Gastrointestinal Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu/Clinical College of Southwest Jiao Tong University · The Affiliated Hospital of Southwest Jiao Tong University, Chengdu 610031, P. R. China;
2. College of Medicine, Southwest Jiaotong University, Chengdu 610031, P. R. China;

Corresponding?author：

LIU Yanjun, Email: liuyanjun_001@163.com

Keywords：

overlap esophagojejunostomy with bidirectional suturing; gastric cancer; total laparoscopic radical; treatment outcomes

DOI：

10.7507/1007-9424.202506037

Video：

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Objective To investigate the application value of the bidirectional sutures method in total laparoscopic radical total gastrectomy with esophagojejunal overlap anastomosis. Methods A retrospective descriptive study was conducted. A retrospective analysis was performed on 128 patients with gastric cancer who underwent totally laparoscopic total gastrectomy (TLTG) in the Department of Gastrointestinal Surgery of Chengdu Third People's Hospital from December 2020 to December 2023. Patients in the observation group underwent bidirectional suture overlap esophagojejunostomy, while patients in the control group received conventional overlap side-to-side esophagojejunostomy. The two groups were then compared based on clinical outcome measures. Results A total of 128 patients were included, including 80 in the observation group and 48 in the control group. The anastomosis time ［(25.75±5.78) min vs (29.43±2.73) min, P＜0.001］, operative time ［(244.81±39.16) min vs (257.18±44.36) min, P=0.037］, time to postoperative flatus ［(2.30±0.80) d vs (2.85±1.33) d, P=0.004］, and postoperative hospital stay ［(7.15±2.10) d vs (9.00±2.66) d, P＜0.001］of the observation group shorter than those in the control group. In the observation group, anastomotic leakage occurred in one patient (Clavien-Dindo grade Ⅱ), who improved with conservative treatment and was discharged. All patients were successfully followed up at 1, 3, 6, and 12 months after surgery, and the median follow-up time was 12 months. During follow-up, four deaths occurred (two in the observation group and two in the control group), all non-cancer-related. No other complications, recurrences, or metastases were observed. Conclusions The bidirectional suture overlap esophagojejunostomy is a safe and feasible technique for performing a totally laparoscopic radical total gastrectomy, providing favorable short-term effects.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
3.	Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin, 2024, 74(1): 12-49.
4.	Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
5.	Inaba K, Satoh S, Ishida Y, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg, 2010, 211(6): e25-29. doi: 10.1016/j.jamcollsurg.2010.09.005.
6.	Park KB, Kim EY, Song KY. Esophagojejunal anastomosis after laparoscopic total gastrectomy for gastric cancer: circular versus linear stapling. J Gastric Cancer, 2019, 19(3): 344-354.
7.	Son SY, Cui LH, Shin HJ, et al. Modified overlap method using knotless barbed sutures (MOBS) for intracorporeal esophagojejunostomy after totally laparoscopic gastrectomy. Surg Endosc, 2017, 31(6): 2697-2704.
8.	Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today, 2016, 46(6): 668-685.
9.	Song KY, Park CH, Kang HC, et al. Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study. J Gastrointest Surg, 2008, 12(6): 1015-1021.
10.	Xi HQ, Cui JX, Chen L. Current status of laparoscopic surgery for gastric cancer. Chin Med J, 2013, 126(16): 3003-3005.
11.	Wang J, Liu S, Chen H, et al. Final results of a randomized controlled trial: comparison of the efficacy and safety between totally laparoscopic and laparoscopic-assisted total gastrectomy for advanced Siewert Ⅲ esophagogastric junction cancer and upper and middle third gastric cancer. Int J Surg, 2025, 111(1): 686-696.
12.	Lee TG, Lee IS, Yook JH, et al. Totally laparoscopic total gastrectomy using the overlap method; early outcomes of 50 consecutive cases. Surg Endosc, 2017, 31(8): 3186-3190.
13.	Bracale U, Peltrini R, De Luca M, et al. Predictive factors for anastomotic leakage after laparoscopic and open total gastrectomy: a systematic review. J Clin Med, 2022, 11(17): 5022. doi: 10.3390/jcm11175022.
14.	Trapani R, Rausei S, Reddavid R, et al. Risk factors for esophago-jejunal anastomosis leakage after total gastrectomy for cancer. A multicenter retrospective study of the Italian research group for gastric cancer. Eur J Surg Oncol, 2020, 46(12): 2243-2247.
15.	Kamarajah SK, Navidi M, Griffin SM, et al. Impact of anastomotic leak on long-term survival in patients undergoing gastrectomy for gastric cancer. Br J Surg, 2020, 107(12): 1648-1658.
16.	Schneider MA, Kim J, Berlth F, et al. Reconstruction techniques and associated morbidity in minimally invasive gastrectomy for cancer: insights from the GastroBenchmark and GASTRODATA databases. Ann Surg, 2024, 280(5): 788-798.
17.	Xu B, Zhang F, Peng Y, et al. Predicting esophagojejunal anastomotic leakage in gastric cancer patients after total gastrectomy: development and assessment of a new predictive nomogram. Asian J Surg, 2024, 47(1): 528-530.
18.	He Z, Liu H, Zhou L, et al. Risk factors and conservative therapy outcomes of anastomotic leakage after gastrectomy: experience of 3 926 patients from a single gastric surgical unit. Front Oncol, 2023, 13: 1163463. doi: 10.3389/fonc.2023.1163463.
19.	柏豪, 鄧潤菊, 何海燕. 胃癌病人胃切除術后吻合口瘺影響因素的Meta分析. 循證護理, 2025, 11(11): 2140-2145.
20.	侯洪偉, 王鳳力, 閆永鑫. 不同食管-空腸吻合口加固方法在腹腔鏡輔助全胃切除術中的應用效果. 中外醫學研究, 2023, 21(22): 17-20.
21.	魏恒明, 李堅, 李鷗, 等. 腹腔鏡下根治性全胃切除術后食管空腸吻合口瘺的危險因素分析. 中國社區醫師, 2021, 37(22): 17-18.
22.	張敬麟, 王默進, 陳心足. 腹腔鏡胃癌根治術中肝臟懸吊技術應用的進展. 中國普外基礎與臨床雜志, 2024, 31(7): 876-880.
23.	Umemura A, Koeda K, Sasaki A, et al. Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg, 2015, 38(2): 102-112.
24.	劉金生, 吳燕, 張寧, 等. 全腹腔鏡全胃切除術食管空腸π形吻合與overlap吻合臨床效果比較. 中國現代手術學雜志, 2023, 27(4): 275-281.
25.	李鋒, 彭德偉, 李文藝, 等. Overlap吻合與π吻合在全腹腔鏡全胃切除術中的應用. 鄭州大學學報 (醫學版), 2024, 59(04): 531-536.
26.	Caulk AW, Chatterjee M, Barr SJ, et al. Mechanobiological considerations in colorectal stapling: Implications for technology development. Surg Open Sci, 2023, 13: 54-65.
27.	Fan H, Wang D, Ding P, et al. Application value of continuous seromuscular layer sutures in the reinforcement of esophagojejunostomy in total gastrectomy for gastric cancer: a retrospective comparative cohort study. J Gastrointest Oncol, 2022, 13(6): 2749-2757.
28.	Wei JP, Wang WD, Yang XS, et al. Comparing intracorporeal mechanical anastomosis vs.hand-sewn esophagojejunostomy after total laparoscopic gastrectomy for esophagogastric junction cancer: a single-center study. World J Surg Oncol, 2023, 21(1): 12. doi: 10.1186/s12957-023-02889-y.
29.	Morgan RB, Shogan BD. The science of anastomotic healing. Semin Colon Rectal Surg, 2022, 33(2): 100879. doi: 10.1016/j.scrs.2022.100879.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
3. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin, 2024, 74(1): 12-49.
4. Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
5. Inaba K, Satoh S, Ishida Y, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg, 2010, 211(6): e25-29. doi: 10.1016/j.jamcollsurg.2010.09.005.
6. Park KB, Kim EY, Song KY. Esophagojejunal anastomosis after laparoscopic total gastrectomy for gastric cancer: circular versus linear stapling. J Gastric Cancer, 2019, 19(3): 344-354.
7. Son SY, Cui LH, Shin HJ, et al. Modified overlap method using knotless barbed sutures (MOBS) for intracorporeal esophagojejunostomy after totally laparoscopic gastrectomy. Surg Endosc, 2017, 31(6): 2697-2704.
8. Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today, 2016, 46(6): 668-685.
9. Song KY, Park CH, Kang HC, et al. Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study. J Gastrointest Surg, 2008, 12(6): 1015-1021.
10. Xi HQ, Cui JX, Chen L. Current status of laparoscopic surgery for gastric cancer. Chin Med J, 2013, 126(16): 3003-3005.
11. Wang J, Liu S, Chen H, et al. Final results of a randomized controlled trial: comparison of the efficacy and safety between totally laparoscopic and laparoscopic-assisted total gastrectomy for advanced Siewert Ⅲ esophagogastric junction cancer and upper and middle third gastric cancer. Int J Surg, 2025, 111(1): 686-696.
12. Lee TG, Lee IS, Yook JH, et al. Totally laparoscopic total gastrectomy using the overlap method; early outcomes of 50 consecutive cases. Surg Endosc, 2017, 31(8): 3186-3190.
13. Bracale U, Peltrini R, De Luca M, et al. Predictive factors for anastomotic leakage after laparoscopic and open total gastrectomy: a systematic review. J Clin Med, 2022, 11(17): 5022. doi: 10.3390/jcm11175022.
14. Trapani R, Rausei S, Reddavid R, et al. Risk factors for esophago-jejunal anastomosis leakage after total gastrectomy for cancer. A multicenter retrospective study of the Italian research group for gastric cancer. Eur J Surg Oncol, 2020, 46(12): 2243-2247.
15. Kamarajah SK, Navidi M, Griffin SM, et al. Impact of anastomotic leak on long-term survival in patients undergoing gastrectomy for gastric cancer. Br J Surg, 2020, 107(12): 1648-1658.
16. Schneider MA, Kim J, Berlth F, et al. Reconstruction techniques and associated morbidity in minimally invasive gastrectomy for cancer: insights from the GastroBenchmark and GASTRODATA databases. Ann Surg, 2024, 280(5): 788-798.
17. Xu B, Zhang F, Peng Y, et al. Predicting esophagojejunal anastomotic leakage in gastric cancer patients after total gastrectomy: development and assessment of a new predictive nomogram. Asian J Surg, 2024, 47(1): 528-530.
18. He Z, Liu H, Zhou L, et al. Risk factors and conservative therapy outcomes of anastomotic leakage after gastrectomy: experience of 3 926 patients from a single gastric surgical unit. Front Oncol, 2023, 13: 1163463. doi: 10.3389/fonc.2023.1163463.
19. 柏豪, 鄧潤菊, 何海燕. 胃癌病人胃切除術后吻合口瘺影響因素的Meta分析. 循證護理, 2025, 11(11): 2140-2145.
20. 侯洪偉, 王鳳力, 閆永鑫. 不同食管-空腸吻合口加固方法在腹腔鏡輔助全胃切除術中的應用效果. 中外醫學研究, 2023, 21(22): 17-20.
21. 魏恒明, 李堅, 李鷗, 等. 腹腔鏡下根治性全胃切除術后食管空腸吻合口瘺的危險因素分析. 中國社區醫師, 2021, 37(22): 17-18.
22. 張敬麟, 王默進, 陳心足. 腹腔鏡胃癌根治術中肝臟懸吊技術應用的進展. 中國普外基礎與臨床雜志, 2024, 31(7): 876-880.
23. Umemura A, Koeda K, Sasaki A, et al. Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg, 2015, 38(2): 102-112.
24. 劉金生, 吳燕, 張寧, 等. 全腹腔鏡全胃切除術食管空腸π形吻合與overlap吻合臨床效果比較. 中國現代手術學雜志, 2023, 27(4): 275-281.
25. 李鋒, 彭德偉, 李文藝, 等. Overlap吻合與π吻合在全腹腔鏡全胃切除術中的應用. 鄭州大學學報 (醫學版), 2024, 59(04): 531-536.
26. Caulk AW, Chatterjee M, Barr SJ, et al. Mechanobiological considerations in colorectal stapling: Implications for technology development. Surg Open Sci, 2023, 13: 54-65.
27. Fan H, Wang D, Ding P, et al. Application value of continuous seromuscular layer sutures in the reinforcement of esophagojejunostomy in total gastrectomy for gastric cancer: a retrospective comparative cohort study. J Gastrointest Oncol, 2022, 13(6): 2749-2757.
28. Wei JP, Wang WD, Yang XS, et al. Comparing intracorporeal mechanical anastomosis vs.hand-sewn esophagojejunostomy after total laparoscopic gastrectomy for esophagogastric junction cancer: a single-center study. World J Surg Oncol, 2023, 21(1): 12. doi: 10.1186/s12957-023-02889-y.
29. Morgan RB, Shogan BD. The science of anastomotic healing. Semin Colon Rectal Surg, 2022, 33(2): 100879. doi: 10.1016/j.scrs.2022.100879.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesApplication of bidirectional sutures in total laparoscopic radical total gastrectomy with esophagogastric overlap anastomosis

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