A Bidirectional Barbed Suture Technique for Secure Entry-hole Closure in Robotic Overlap Esophagojejunostomy: Initial Experience.

Authors

Hironori Tsujimoto, Keita Kouzu, Yoshihisa Yaguchi, Hiroyuki Horiguchi, Naoyuki Uehata, Risa Kariya, Asuma Ide, Seiichiro Fujishima, Takafumi Suzuki, Masahiro Takei, Hiroki Tashiro, Hideki Ueno

Published in

JMA journal. Volume 9. Issue 5. Pages 1238-1243. Sep 15, 2026. Epub Jul 24, 2026.

Abstract

Although minimally invasive total and proximal gastrectomy have been increasingly adopted for gastric cancer, anastomotic complications, particularly at the esophagojejunal anastomosis, remain more frequent than after distal gastrectomy. Anastomotic leakage or stenosis can delay postoperative recovery and the initiation of adjuvant chemotherapy, thereby potentially affecting oncologic outcomes. Reliable entry-hole closure during overlap esophagojejunostomy remains technically challenging, especially when luminal diameter mismatch exists between the esophagus and jejunum.
We describe an entry-hole closure technique using a bidirectional barbed suture during robotic overlap esophagojejunostomy. Ten consecutive patients undergoing robotic gastrectomy for gastric cancer (five total gastrectomies with Roux-en-Y reconstruction and five proximal gastrectomies with double-tract reconstruction) were included. Following stapled overlap anastomosis, the entry hole was closed intracorporeally using a STRATAFIX^Ⓡ Spiral PDS Plus^Ⓡ bidirectional barbed suture. Suturing was initiated at the midpoint of the entry hole and proceeded continuously toward both the distal and proximal ends, allowing tension adjustment and full-thickness layer capture without the need for terminal knot fixation.
Entry-hole closure was successfully completed in all patients without conversion. The mean closure time was 15.6 ± 2.3 minutes. No patients experienced anastomotic leakage, stenosis, or other anastomosis-related complications during the postoperative course.
This technique appears technically feasible and safe in this initial experience and may facilitate secure entry-hole closure during robotic overlap esophagojejunostomy.

PMID:
42840771
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.