Overlap Anastomosis for Digestive Reconstruction during Laparoscopic Distal Gastrectomy with Intensive Regional Lymph Node Dissection: Physiological Impact of Preserving the Mesenteric Autonomic Nerves in the Lifted Jejunal Limb

Figure 3

(a) A small number of seromuscular sutures were required at the tip of the endostapler. (b) We set the length of the staple line at 35–40 mm for ideal side-to-side stapled anastomosis (red area). The endostapler entry site was carefully closed, and the inverted staple line in the gastric remnant was covered. (c) Through a small laparotomy, gaps in the mesojejunum could be closed even along the upper side of the mesocolon (red arrow). Therefore, intracorporeal sutures were required to close gaps in the mesojejunum only along the upper side of the mesocolon (blue arrow). (d) Through a small laparotomy, gaps in the mesojejunum from Treitz’s ligament (dotted red arrow) and the lower side of the mesocolon along the retrocolic route (dotted red arrow) could be closed. Intracorporeal sutures to close gaps in the mesojejunum were minimized (blue solid arrow) because of the closure along the upper side of the mesocolon through the small laparotomy (red solid arrow).

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