An improved technique for a stapled transabdominal esophagojejunostomy

BACKGROUND: In the performance of a stapled transabdominal esophagojejunostomy there are two main technical problems involved and related to a difficult surgical exposure. One is the placement of the purse-string suture and the second is the insertion of the anvil of the circular intraluminal stapler into the distal esophagus. METHODS: These technical difficulties can be overcome by opening just the anterior wall of the esophagus at the anastomosis level, leaving the posterior wall intact. 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 avoids stay sutures, purse-string instruments, and forceful instrumental dilatation of the distal esophagus, making these very important operative steps much easier, safer, and more reliable. (C) 1997 by Excerpta Medica, Inc.