How to examine anastomotic integrity intraoperatively in totally laparoscopic radical gastrectomy? Methylene blue testing prevents technical defect-related anastomotic leaks

Figure 1 Schematic representation of intraoperative methylene blue testing. A: Overlap anastomosis; B: Billroth-II anastomosis.

Figure 2 Surgery pictures and schematic pictures of intraoperative methylene blue testing. A: Surgery picture of esophagojejunostomy (overlap method); A’: Schematic picture of esophagojejunostomy (overlap method); B: Surgery picture of intraoperative methylene blue testing in totally laparoscopic total gastrectomy; B’: Schematic picture of intraoperative methylene blue testing in totally laparoscopic total gastrectomy; C: Surgery picture of Billroth-II anastomosis; C’: Schematic picture of Billroth-II anastomosis; D: Surgery picture of intraoperative methylene blue testing in totally laparoscopic distal gastrectomy; D’: Schematic picture of intraoperative methylene blue testing in totally laparoscopic distal gastrectomy.

Figure 3 Positive results of intraoperative methylene blue testing.

Figure 4 Schematic representation of study protocol and results. IMBT: Intraoperative methylene blue testing.