Laparoscopic omental patch repair of perforated duodenal ulcer with an automated stapler

✍ Scribed by A. Nassar; P. A. Super; A. Darzi

• Publisher: John Wiley and Sons
• Year: 1994
• Tongue: English
• Weight: 122 KB
• Volume: 81
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800810952

✦ Synopsis

Double-stapling technique for mechanical circular oesophagqejunal anastomosis after total gastrectomy

Sir

We read with interest the article by Dr Tejero Cebriin and colleagues (Br J Surg 1994; 81: 408-9) regarding a new technique of cross-stapling in the construction of an oesophagojejunal anastomosis. We agree wholehearted that insertion of a hand-sewn purse string into the distal oesopiagus can be difficult, time consuming and tedious. The method described by Cebriain seems rather complex and, theoretically, has the unreliability of all crossstapled anastomoses.

However, there is another much simpler technique using the disposable Auto Suture Purstring 45 (US Surgical, Norwalk, Connecticut, USA) instrument. This technique places a circumferential strand of 2/0 nylon suture, which is held in position by stainless steel staples. The procedure itself is very simple and involves placing the mobilized oesophagus within the jaws of the instrument and activating the latter by squeezing the handles. This manoeuvre obviates both a hand-sewn purse string and the rather complicated doublestapling technique described in the article.