A novel abdominal wall retractor to complete laparoscopic intracorporeal circular-stapled esophagojejunostomy after radical gastric cancer surgery—a single-center clinical study

BackgroundExploring effective, safe, and minimally traumatic anastomosis methods after total gastrectomy has been a key research focus, particularly for esophagojejunal anastomosis. Laparoscopic circular stapling is a novel technique for esophagointestinal anastomosis; however, its efficacy requires further validation. This study investigated the differences in outcomes and learning curve between this approach and traditional open anastomosis.MethodsWe retrospectively analyzed patients who underwent a total gastrectomy for gastroesophageal junction cancer at our center between November 2023 and April 2025. The patients were divided into two groups based on the anastomotic technique used. We compared the general characteristics, pathological data, and postoperative recovery outcomes of the conventional open anastomosis and laparoscopic circular stapling groups. Additionally, we employed the cumulative sum method and moving average technique to determine laparoscopic circular stapling learning curve and compared surgical efficacy before and after overcoming the learning curve.ResultsEighty-four patients were included in this study: 33 in the laparoscopic circular stapling group and 51 in the traditional open anastomosis group. No statistically significant differences were observed in baseline characteristics between the two groups. However, the conventional anastomosis group demonstrated significantly shorter operative and anastomosis times than the circular stapling group. No significant differences were found in postoperative recovery or complication rates between the two approaches. The learning curve for laparoscopic circular stapling was estimated to plateau after approximately 11 patients. Before reaching the learning curve threshold, both the operative and anastomosis times were significantly longer, whereas no statistically significant differences in the surgical outcomes were observed before and after mastering the technique.ConclusionsLaparoscopic circular stapling for esophagojejunal anastomosis is safe and feasible, demonstrating comparable efficacy to conventional anastomosis while requiring smaller abdominal incisions. Additionally, its relatively short learning curve makes it suitable for broader clinical adoption.