AN IMPROVED TECHNIQUE FOR A STAPLED TRANSABDOMINAL ESOPHAGOJEJUNOSTOMY

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.