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Introduction: We propose a novel technique to close Petersen's defect using barbed sutures and evaluate the safety and usefulness of this technique by assessing postoperative complications and measuring the time required to close Petersen's defect., Materials and Surgical Technique: Petersen's defect was closed laparoscopically with running non-absorbable barbed sutures (V-loc®) after a nodal dissection and reconstruction procedure. First, the transverse colon was elevated cranially, making the dorsal side of the transverse mesocolon a flattened surface. The intersection of the transverse mesocolon and Roux limb mesentery was then identified, and closure was started from this point. We continued to sew the transverse mesocolon and Roux limb mesentery toward the transverse colon with a running suture. At the end of suturing, we placed one or two stitches in the fatty appendices of the transverse colon and cut the free tail of thread as short as possible., Discussion: We investigated postoperative complications and measured the time required to close Petersen's defect in 64 patients who underwent this technique. The results showed that this closure technique could be performed promptly and safely regardless of the patient, surgical procedure, and the experience of the operator., (© 2019 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.)

Introduction: When esophagojejunostomy is performed using a circular stapler after laparoscopic total gastrectomy, fixing the anvil to the end of the esophagus is challenging. We describe an easy method for fixation of the anvil using a one-handed sliding-knot technique after the anvil has been inserted into the esophagus., Materials and Surgical Technique: After removing the stomach, the main operator makes a whip stitch at the end of the esophagus using a long piece of monofilament string. Both ends of the string are pulled out from the port. A knot is then made and brought close the esophagus twice (sliding granny knots). After inserting the anvil into the esophagus, the main operator pulls the main standing string with one hand, applying vibration only. This causes the knots to tighten the anvil. Then, one or two knots are added to make sure that the anvil is firmly fixed in place. In addition, we routinely add one more ligation with a ready-made ligating loop., Discussion: This method is easy and reliable, and does not require special devices or skills when performing reconstruction after laparoscopic total gastrectomy. Because of these factors, it has the potential to be widely used to perform esophagojejunostomy., (© 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.)