Intrathoracic esophagojejunostomy using OrVil™ for gastric adenocarcinoma involving the esophagus

Figure 1 Intraabdominal findings of an esophagojejunostomy using a circular stapler. A: Transection of the esophagus was performed approximately 2 cm proximal to the tumor margin using an Endo GIA (60 purple; Covidien, Tokyo, Japan) linear stapler; B: The OrVil™ tube was then introduced transorally into the esophagus; C: A circular stapler (DST Series EEA Stapler 25; Covidien Japan) was inserted into the jejunal stump and the anvil was connected to the circular stapler; D: After the anastomosis, a Salem Sump Dual Lumen Stomach Tube (16 Fr; Covidien Japan) for the anastomotic site was inserted from the anterior chest wall through the space between the pericardium and diaphragm and positioned in the left-sided chest cavity (white arrow). Eso: Esophagus; DH: Diaphragm.

Figure 2 Postoperative fluoroscopy. Anastomosis of the esophagojejunostomy was 6.4 cm above the diaphragm (black arrowhead) with no anastomotic leakage or stenosis.