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Endoscopic management of pseudo-lumen stapling following laparoscopic esophagojejunostomy: A case report.

Authors
  • Lee, Seung Soo1
  • 1 Department of Surgery, Kyungpook National University Hospital 130 Dongdeok-ro, Jung-gu, Daegu 41944, Republic of Korea. Electronic address: [email protected]. , (North Korea)
Type
Published Article
Journal
International Journal of Surgery Case Reports
Publisher
Elsevier
Publication Date
Oct 01, 2023
Volume
111
Pages
108830–108830
Identifiers
DOI: 10.1016/j.ijscr.2023.108830
PMID: 37716056
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Pseudo-lumen stapling can occur following an incidental submucosal introduction of a fork of the linear stapler into the esophageal side during esophagojejunostomy (EJS) after total gastrectomy. This leaves a mucosa-covered layer over the EJS site that can eventually cause an obstruction. If it is noticed intraoperatively, an immediate surgical take-down and repeat anastomosis might be chosen by most surgeons. However, these procedures might have side effects such as further dissection into the esophageal hiatus and unnecessary tension on the anastomosis. To our knowledge, no existing publication has presented a non-surgical management method for pseudo-lumen stapling. A 64-year-old male underwent laparoscopic total gastrectomy with a pseudo-lumen stapling unnoticed during surgery. Upon its recognition on the third postoperative day, endoscopic release of the tissue covering the anastomosis was performed. The procedure was successful. Gastrographic examination on the sixth postoperative day confirmed a good passage of the contrast agent. Postoperative one-year endoscopic examination confirmed patent anastomosis without stenosis. Although pseudo-lumen stapling is one of the most unwanted consequences of EJS using linear staplers, there is little information or documentation available as reference for cases encountered during clinical practice. This might be related to the tendency of surgeons to perform an immediate take-down, followed by repeat EJS when this is noticed during surgery. We were able to successfully overcome this problem without surgery following a series of early gastrographic and endoscopic procedures. Endoscopic release of the covering tissue should be considered a valid non-surgical solution to pseudo-lumen stapling. Copyright © 2023 The Author. Published by Elsevier Ltd.. All rights reserved.

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