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

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.