BACKGROUND: In the performance of a stapled transabdominal esophagojej
unostomy there are two main technical problems involved and related to
a difficult surgical exposure. One is the placement of the purse-stri
ng suture and the second is the insertion of the anvil of the circular
intraluminal stapler into the distal esophagus. METHODS: These techni
cal difficulties can be overcome by opening just the anterior wall of
the esophagus at the anastomosis level, leaving the posterior wall int
act. RESULTS: The integrity of the posterior wall avoids retraction of
the mucosa, allowing the esophagus to remain opened for the placement
of a through and through purse-string suture under direct vision, It
also acts as a conduit for the insertion of the anvil of the circular
intraluminal stapler. CONCLUSIONS: The technique described herein avoi
ds stay sutures, purse-string instruments, and forceful instrumental d
ilatation of the distal esophagus, making these very important operati
ve steps much easier, safer, and more reliable. (C) 1997 by Excerpta M
edica, Inc.