An Anastomotic Obstruction That Developed after Laparoscopic Total Gastrectomy, Subsequently Treated with Magnetic Compression Anastomosis

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 49; no. 9; pp. 850 - 856
• Main Authors: Ito, Eisaku, Ohdaira, Hironori, Saito, Nobuhiro, Ryu, Shunjin, Tsutsui, Nobuhiro, Yoshida, Masashi, Yanagisawa, Satoru, Yamanouchi, Eigoro, Suzuki, Yutaka
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.09.2016
• Subjects: anastomotic stricture; total gastrectomy; Yamanouchi method
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.2015.0060

A 53-year old woman underwent laparoscopic total gastrectomy to treat gastric cancer. Roux-en-Y reconstruction was performed with functional end-to-end anastomosis (FEEA). Endoscopic treatment was repeated after obstruction due to kinking at the anastomosis site developed postoperatively. The treatment proved ineffective, however, and at one postoperative year the patient underwent magnetic compression anastomosis (Yamanouchi method). After the magnetic compression anastomosis, the patient was able to eat a sufficient amount. The causes of the patient’s anastomotic kink were inferred to involve the migration of the anastomotic site to the mediastinal space, adhesion between the anastomotic staple and the jejunum, and shrinkage of the esophagus after surgery. Magnetic compression anastomosis is a fistula-creating technique that uses two magnets to sandwich the luminal organ causing tissue necrosis. In our case, the anastomotic site was located in the mediastinal space and re-anastomotic surgery was considered difficult. This was a good indicator for magnetic compression anastomosis because the target organs were very close together, making them feasible to sandwich with magnets.