A Novel Technique for Intracorporeal End-to-End Anastomosis in Totally Laparoscopic Colectomy: A Preliminary Single-Center Experience

Background: Recently, several studies have demonstrated the feasibility and effectiveness of totally laparoscopic colectomy with intracorporeal anastomosis. In this study, we describe our novel technique for intracorporeal end-to-end anastomosis, which we have named the modified book-binding technique (MBBT), in totally laparoscopic colectomy, and present our preliminary experience in clinical practice. Patients and Methods: MBBT is performed as follows: (1) the 45-mm endoscopic linear stapler is inserted parallel into each hole at the mesenteric side of the proximal and distal ends of the bowel; (2) before stapling, the ends of the bowel are repositioned such that the oral side of the stapler tip is pushed toward the oral bowel, and the anal side is pushed toward the anal bowel, with the root side of the stapler remaining as a pivot point. Then, the stapler is inserted deeply; (3) the anterior wall of the bowel is excised according to ischemia; (4) the anterior wall of the bowel is stapled again in 2 parts using the 60-mm endoscopic linear stapler. Results: A total of 7 patients underwent totally laparoscopic colectomy using this technique. One patient experienced postoperative ileus. There were no other postoperative complications, including anastomotic leakage or intraperitoneal abscess. All patients have survived without any recurrence or late-phase complications. Conclusion: This novel technique has a feasibility for end-to-end anastomosis in totally laparoscopic colectomy, ensuring a sufficient anastomotic area. MBBT could be an alternative method of intracorporeal anastomosis.