Gastrointestinal anastomosis technique, Roux-en-Y esophagojejunostomy

The video starts with the transection of the anterior vagus branch. Then, the distal esophagus is opened halfway on its anterior side and secured with a proximally placed Allis clamp, which prevents thoracic retraction of the distal esophagus. This is followed by the transection of the posterior esophageal wall. Placement of a purse-string suture (monofilament, non-absorbable suture of size 2-0, overhand) and gentle dilation of the esophageal lumen using dressing forceps. Insertion of the anvil of a CEEA stapler, which is fixed by tying the pre-placed purse-string suture.

To achieve a good functional result, it is necessary to prepare a sufficiently long jejunum segment. For this purpose, the transverse colon is flipped up and the vascular supply of the second jejunal loop is assessed by holding up and spreading out the mesentery under transillumination with the OR light. The small intestine and mesentery of the efferent loop should be transected in such a way that they can be easily brought up to the esophagus.

Incision of the mesenteric peritoneum and gentle division of the mesenteric vascular arcades, which is chosen in such a way that the blood supply at the site of intestinal division is secured. Subsequently, open transection of the intestine with the electric knife.