An improved technique for a stapled transabdominal esophagojejunostomy

background In the performance of a stapled transabdominal esophagojejunostomy there are two main technical problems involved and related to a difficult surgical exposure. One is the placement of the purse-string suture and the second is the insertion of the anvil of the circular intraluminal stapler into the distal esophagus. methods These technical difficulties can be overcome by opening just the anterior wall of the esophagus at the anastomosis level, leaving the posterior wall intact. results The integrity of the posterior wall avoids retraction of the mucosa, allowing the esophagus to remain opened for the placement of a through and through purse-string suture under direct vision. It also acts as a conduit for the insertion of the anvil of the circular intraluminal stapler. conclusions The technique described herein avoids stay sutures, purse-string instruments, and forceful instrumental dilatation of the distal esophagus, making these very important operative steps much easier, safer, and more reliable.