Gong L, Yu J, Lv ZB, Qin XZ, Li M, Guo W, Huang B, Tian YH. Reducing anastomotic complications with endoscopy in laparoscopic total gastrectomy. World J Gastrointest Surg 2025; 17(12): 114079 [DOI: 10.4240/wjgs.v17.i12.114079]
Corresponding Author of This Article
Yun-Hong Tian, MD, PhD, Chief Physician, Professor, Department of General Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, No. 97 Renmin South Road, Shunqing District, Nanchong 637000, Sichuan Province, China. drtianyunhong@126.com
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Surgery
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 27, 2025 (publication date) through Dec 25, 2025
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Publication Name
World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Gong L, Yu J, Lv ZB, Qin XZ, Li M, Guo W, Huang B, Tian YH. Reducing anastomotic complications with endoscopy in laparoscopic total gastrectomy. World J Gastrointest Surg 2025; 17(12): 114079 [DOI: 10.4240/wjgs.v17.i12.114079]
World J Gastrointest Surg. Dec 27, 2025; 17(12): 114079 Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.114079
Reducing anastomotic complications with endoscopy in laparoscopic total gastrectomy
Lei Gong, Jing Yu, Zhen-Bing Lv, Xiang-Zhi Qin, Min Li, Wei Guo, Bin Huang, Yun-Hong Tian
Lei Gong, Jing Yu, Zhen-Bing Lv, Xiang-Zhi Qin, Min Li, Wei Guo, Bin Huang, Yun-Hong Tian, Department of General Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
Co-first authors: Lei Gong and Jing Yu.
Author contributions: Gong L wrote the article and conducted the statistical analysis; Yu J collected the clinical data and abstracted the data; Gong L and Yu J contributed equally to this article and are the co-first authors of this manuscript; Lv ZB, Qin XZ, Li M, Guo W, and Huang B participated in modification and data analysis; Tian YH and Gong L designed the research protocols for the present study, provided guidance for writing and revising the article. All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Nanchong Central Hospital Affiliated to North Sichuan Medical College (Approval No. 2022012).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All relevant data are included in the paper, and no additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun-Hong Tian, MD, PhD, Chief Physician, Professor, Department of General Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, No. 97 Renmin South Road, Shunqing District, Nanchong 637000, Sichuan Province, China. drtianyunhong@126.com
Received: September 11, 2025 Revised: September 23, 2025 Accepted: October 27, 2025 Published online: December 27, 2025 Processing time: 105 Days and 11.3 Hours
Abstract
BACKGROUND
Early postoperative anastomosis-related complications are frequently associated with technical defects during the anastomotic procedure. Few studies focused on intraoperative anastomotic complications in esophagojejunostomy with circular stapler.
AIM
To explore whether endoscopic examination could reduce the occurrence of early postoperative anastomotic complications.
METHODS
Clinical data from 160 patients with gastric cancer who underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler at Nanchong Central Hospital from January 2020 to December 2023 were retrospectively analyzed. Based on whether intraoperative endoscopic examination (IEE) was performed, patients were divided into the IEE group and the non-IEE (NIEE) group.
RESULTS
All patients successfully underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler. In the IEE group, 7 (8.8%) patients were found to have anastomotic defects: 3 (3.8%) air leaks, 2 (2.5%) bleeding, 1 (1.3%) stricture and 1 (1.3%) full-thickness tearing. Three patients with anastomotic discontinuities were subsequently treated with additional suturing. One anastomotic bleeding was managed with laparoscopic suturing, and another was treated with endoscopic clips. One patient had anastomotic stricture, which was corrected intraoperatively. One patient experienced full-thickness tearing caused by the circular stapler, necessitating a redo anastomosis. These anastomotic defects were repaired intraoperatively, and no postoperative anastomotic complications occurred. 6 (7.5%) patients with postoperative anastomotic complications were observed in the NIEE group. The NIEE group had a significantly higher incidence of postoperative anastomosis-related complications compared to the IEE group (7.5% vs 0%; P = 0.029).
CONCLUSION
Routine IEE significantly reduces early anastomotic complications by enabling immediate detection and repair of technical defects in esophagojejunostomy with circular stapler.
Core Tip: This study demonstrates that routine intraoperative endoscopic examination (IEE) during circular stapler esophagojejunostomy significantly reduces early anastomotic complications by enabling immediate detection and repair of technical defects such as leaks, bleeding, strictures, and full-thickness tears. In a retrospective analysis of 160 patients undergoing laparoscopic total gastrectomy, the IEE group had no postoperative anastomotic complications compared to 7.5% in the non-IEE group, despite a modest increase in operative time. These findings support the integration of IEE as a standard practice to enhance surgical safety and outcomes in gastric cancer surgery.
