Reducing anastomotic complications with endoscopy in laparoscopic total gastrectomy

Figure 1 Esophagojejunostomy with a circular stapler and leak test using the gastroscopic-assisted monitoring procedure. A: Under the guidance of a nasogastric tube, the right esophageal wall was opened using an ultrasonic scalpel; B: The anvil head was inserted; C: The esophagus was transected at the predetermined site using a linear stapler; D: The anvil head was extracted; E: Esophagojejunostomy was completed by connecting the anvil head to the anvil rod; F: The distal jejunum stump was closed with a linear stapler; G: Intraoperative endoscopic examination were performed to assess anastomotic integrity.

Figure 2 Management of esophagojejunal anastomotic stricture. A: An incision was made along the jejunal anterior wall of the anastomosis; B: The stapled contralateral mucosa was completely incised; C: A gastric tube was placed passing through the distal of the anastomosis; D: Suturing was performed with the guidance of gastric tube as a stent; E: The gastroscope successfully passed through the anastomosis.

Figure 3 Management of esophagojejunal anastomotic full-thickness tearing. A: Side-to-side small intestinal anastomosis for jejunal pouch creation was performed extracorporeally; B: The circular stapler’s center rod emerged from the pouch apex extracorporeally; C: Esophagojejunostomy was completed laparoscopically; D: The common entry hole was closed with continuous sutures; E: Laparoscopic reinforcement of the suture line was performed with a continuous seromuscular suture.