A video demonstration of the Li's anastomosis-the key part of the "non-tube no fasting" fast track program for resectable esophageal carcinoma

Abstract

The main obstacle of fast track surgery for esophagectomy is early oral feeding. The main concern of early oral feeding is the possibility of increasing the incidence of anastomotic leakage. Dr. Yin Li used the Li's anastomosis to ensure oral feeding at will the first day after esophagectomy. This safe and efficient anastomosis method significantly reduced the anastomotic leak rate, the number of post-operative days and stricture. Importantly, the "non-tube no fasting" fast track program for esophageal cancer patients was conducted smoothly with Li's anastomosis. This article was focused on the surgical procedure of Li's anastomosis.

Keywords: Esophageal carcinoma; Li’s anastomosis; fast track surgery; non-tube no fasting; thoracolaparoscopic esophagectomy.

Figure 1

A video demonstration of the Li’s anastomosis—the key part of the “non-tube no fasting” fast track program for resectable esophageal carcinoma (8). Available online: http://www.asvide.com/articles/611

Figure 2

(A) Four interrupted sutures between the muscularis layer of the esophagus and the seromuscular layer of the stomach; (B) three-leaf clamp to fix the gastric conduit and esophageal stump. Open the muscularis layer of the esophagus. Seven to eight interrupted stitches between the muscularis layer of the esophagus and the seromuscular layer of the stomach; (C) esophageal stump was cut off; (D and E) continuous sutures between the mucosal layers of esophagus and gastric mucosa layer; (F) release three-leaf clamp. The anterior muscular layer of the esophagus and the seromuscular layer of the stomach were sewn using interrupted sutures; (G) the redundant gastric conduit was cut by a linear stapler; (H and I) embed the redundant gastric conduit into the gastric conduit cavity by forceps; (J) the gastric seromuscular layer and the anterior aspect of the esophageal muscle were sewn by intermittent two sutures together with fundoplication; (K and L) the simplified profile of Li’s anastomosis. A1, A2, A3, A4, A5, A6 (Figure 2A), anastomosis site; V, valve.