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 6

Actual findings via laparoscope during intracorporeal procedures were shown. Co-author, (T) Hori, mainly performed this surgery. (a) The jejunum was lifted through the antecolic route. The sacrificed jejunum contributed well to ideal mesojejunal margins in the lifted jejunal limb (blue arrow). The jejunal limb could be lifted with no tension on the retracted mesojejunum (red arrow). (b) Under countertraction by the two grasping sutures (red arrows), the endostapler was guided into the lifted jejunal limb. (c) Staple lines for surgical anastomosis should be set at 35–40 mm (red arrow). The length of linear staple line was optimally adjusted in the isoperistaltic side-to-side fashion (blue arrows). (d) Postoperative passage depends on patency at the functional anastomosis (blue area). The inverted staple line in the gastric remnant was covered (yellow arrows).

(a)

(b)

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