Intracorporeal Circular-Stapled Roux-en-Y Reconstruction in Totally Laparoscopic Distal Gastrectomy: Laparoscopic Purse-String Suture Clamp and Multifunctional Seal Cap Technique.

Abstract

Background: Totally laparoscopic distal gastrectomy (TLDG) has become one of the standard surgical procedures for early and advanced gastric cancer. The Roux-en-Y reconstruction is the most commonly used method after TLDG to effectively prevent bile reflux esophagitis and residual gastric inflammation. Gastrojejunal Roux-en-Y reconstruction mainly includes 3 types of anastomosis: circular, linear, and manual. Circular-stapled anastomosis is frequently used in open gastrointestinal surgery. However, it faces significant technical challenges. The study aimed to evaluate the feasibility and safety of using a laparoscopic purse-string suture clamp (Lap-PSC) and a multifunctional seal cap (MSC) for gastrojejunal Roux-en-Y circular anastomosis, aiming to establish a new standard method for Roux-en-Y reconstruction in TLDG.

Methods: A multicenter retrospective analysis was conducted on 101 gastric cancer patients undergoing TLDG with Lap-PSC and MSC from October 2023 to April 2025, with all patients receiving intracorporeal gastrojejunal Roux-en-Y circular anastomosis. Surgical details and postoperative outcomes were analyzed to evaluate this method.

Results: All 101 patients underwent successful TLDG with negative resection margins, defined as completion without intraoperative complications or conversion. The mean operation time was 187.5±36.4 minutes. The mean time for the purse-string suture was 7.2±2.5 minutes, and an average of 5.3 minutes was required for anvil placement. The overall incidence of early postoperative complications was 9.9% in this study. 1 patient (1.0%) experienced postoperative gastroparesis, 3 patients (3.0%) had postoperative pneumonia, 3 patients (3.0%) developed abdominal infection, and 2 patients (2.0%) suffered wound infection. During the median follow-up period of 11.8 months, 2 patients (2.0%) experienced gastrojejunostomy stenosis, and both were treated successfully by endoscopic balloon dilation. No anastomotic leaks or perioperative deaths occurred.

Conclusion: The laparoscopic purse-string suture clamp combined with the multifunctional seal cap technique is a safe, feasible, and easily standardized method for circular anastomosis, offering a valuable alternative for gastrojejunal Roux-en-Y reconstruction in TLDG.