Esophagojejunal Anastomosis by Circular Stapler in Pediatric Patients: Size Minima Defined by Experience and Geometry

Ramin Jamshidi; John C. Densmore; David M. Gourlay; Dave R. Lal; Casey M. Calkins

doi:10.1089/lap.2019.0092

Esophagojejunal Anastomosis by Circular Stapler in Pediatric Patients: Size Minima Defined by Experience and Geometry

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2019.0092 ◽

2019 ◽

Vol 29 (10) ◽

pp. 1311-1314

Author(s):

Ramin Jamshidi ◽

John C. Densmore ◽

David M. Gourlay ◽

Dave R. Lal ◽

Casey M. Calkins

Keyword(s):

Pediatric Patients ◽

Circular Stapler ◽

Esophagojejunal Anastomosis

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Step-by-step esophagojejunal anastomosis after intra-corporeal total gastrectomy for laparoscopic gastric cancer treatment: technique of "reverse anvil"

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000100017 ◽

2014 ◽

Vol 27 (1) ◽

pp. 71-76 ◽

Cited By ~ 3

Author(s):

Croider Franco LACERDA ◽

Paulo Anderson BERTULUCCI ◽

Antônio Talvane Torres de OLIVEIRA

Keyword(s):

Total Gastrectomy ◽

Circular Stapler ◽

Jejunal Loop ◽

Linear Stapler ◽

Treatment Technique ◽

Esophagojejunal Anastomosis ◽

Technical Details ◽

Gastric Cancer Treatment ◽

Gastric Tubes ◽

The Moment

Background: The laparoscopic gastrectomy is a relatively new procedure due mainly to the difficulties related to lymphadenectomy and reconstruction. Until the moment, technique or device to perform the esophagojejunal anastomosis by laparoscopy is still a challenge. So, a safe, cheap and quickly performing technique is desirable to be developed. Aim : To present technique proposed by the authors with its technical details on reconstruction with "reverse anvil". Method: After total gastrectomy completed intra-corporeally, the reconstruction starts with the preparation of the intra-abdominal esophagus cross-section next to the esophagogastric transition of 50%. A graduated device is prepared using Levine gastric tubes (nº. 14 and 10), 3 cm length, connected to the anvil of the circular stapler (nº. 25) with a wire thread (2-0 or 3-0) of 10 cm, which is connected to end of this device. The whole device is introduced in reverse esophagus. The esophagus is amputated and the wire is pulled after previous transfixation in the distal esophagus and the anvil positioned. The jejunal loop is sectioned 20-30 cm from duodenojejunal angle, and the anvil put in the jejunal loop and connect previously in the esophagus. Linear stapler (blue 60 mm) is used to close the opening of the jejunal loop. Conclusion: The "reverse anvil" technique used by the authors facilitated the transit reestablishment after total gastrectomy, contributing to obviate reconstruction problems after total gastrectomy.

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Audiology Service Models in a Family Physician Practice Setting

Perspectives on Audiology ◽

10.1044/poa6.1.24 ◽

2010 ◽

Vol 6 (1) ◽

pp. 24-32 ◽

Cited By ~ 2

Author(s):

Sridhar Krishnamurti

Keyword(s):

Pediatric Patients ◽

Practice Patterns ◽

Healthcare Delivery ◽

Direct Consequence ◽

Direct Access ◽

Practice Setting ◽

Pediatric Populations ◽

Family Practice Physicians ◽

Primary Focus ◽

Balance Problems

This article illustrates the potential of placing audiology services in a family physician’s practice setting to increase referrals of geriatric and pediatric patients to audiologists. The primary focus of family practice physicians is the diagnosis/intervention of critical systemic disorders (e.g., cardiovascular disease, diabetes, cancer). Hence concurrent hearing/balance disorders are likely to be overshadowed in such patients. If audiologists get referrals from these physicians and have direct access to diagnose and manage concurrent hearing/balance problems in these patients, successful audiology practice patterns will emerge, and there will be increased visibility and profitability of audiological services. As a direct consequence, audiological services will move into the mainstream of healthcare delivery, and the profession of audiology will move further towards its goals of early detection and intervention for hearing and balance problems in geriatric and pediatric populations.

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