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. 2017 Sep;17(3):267-276.
doi: 10.5230/jgc.2017.17.e26. Epub 2017 Aug 16.

Two-Layer Hand-Sewn Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy for Gastric Cancer

Enrique Norero  1   2 , Rodrigo Muñoz  1   2 , Marco Ceroni  1 , Manuel Manzor  1   2 , Fernando Crovari  2 , Mauricio Gabrielli  2
Affiliations

Two-Layer Hand-Sewn Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy for Gastric Cancer

Enrique Norero et al. J Gastric Cancer. 2017 Sep.

Abstract

Purpose: Different esophagojejunostomy (EJ) reconstruction methods are used after totally laparoscopic total gastrectomy (TLTG), and none is considered a standard technique. This report describes a 2-layer hand-sewn EJ technique during TLTG; we also evaluated postoperative morbidity associated with this technique.

Materials and methods: This retrospective cohort study included all consecutive patients who underwent TLTG for gastric cancer (GC) from 2012 to 2016 at 2 affiliated teaching hospitals. All participating surgeons performed standardized intracorporeal 2-layer hand-sewn EJ.

Results: We included 51 patients who underwent TLTG for GC and standardized EJ anastomosis. Twenty-seven (53%) were male, and the median age was 60 (36-87) years. The average operative time was 337±71 minutes and intraoperative bleeding was 160±107 mL. There were no open conversions related to EJ. Postoperative morbidity was observed in 9 (17.0%) patients. There was no postoperative mortality. EJ leakage was observed in 2 patients (3.8%) and 1 patient (1.9%) developed EJ stenosis. Patients with leakage were managed non-operatively and the patient with stenosis required endoscopic dilation. The median length of hospital stay was 8 (6-29) days.

Conclusions: Two-layer hand-sewn EJ during TLTG for GC is a feasible and safe technique. This method avoids a laparotomy for reconstruction and the disadvantages associated with laparoscopic introduction of mechanical staplers for EJ, and provides an alternative for alimentary tract reconstruction after TLTG.

Keywords: Esophagojejunostomy; Gastrectomy; Laparoscopy; Stomach neoplasms.

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Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Trocar position in laparoscopic total gastrectomy.
Fig. 2
Fig. 2
Two-layer hand-sewn EJ. First posterior layer: a 34-Fr bougie is placed inside the esophagus (A). Suturing the jejunum to the distal end of the esophagus under the complete staple line (B-D). EJ = esophagojejunostomy.
Fig. 3
Fig. 3
Two-layer hand-sewn EJ. The second posterior layer and the first anterior layer: the anterior esophageal wall is opened immediately above the stapler line and an enterotomy is also created in the jejunum (A). A second posterior layer (B-D) and the first anterior layer are formed (E, F). EJ = esophagojejunostomy.
Fig. 4
Fig. 4
Two-layer hand-sewn EJ. A second anterior layer is formed (A, B) and the anastomosis is completed (C, D). EJ = esophagojejunostomy.
See this image and copyright information in PMC

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References

    1. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–148. - PubMed
    1. LaFemina J, Viñuela EF, Schattner MA, Gerdes H, Strong VE. Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol. 2013;20:2975–2983. - PubMed
    1. Moisan F, Norero E, Slako M, Varas J, Palominos G, Crovari F, et al. Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study. Surg Endosc. 2012;26:661–672. - PubMed
    1. Norero E, Báez S, Briceño E, Martínez C, Ceroni M, Escalona A, et al. Totally laparoscopic gastrectomy for the treatment of gastric tumors. Rev Med Chil. 2015;143:281–288. - PubMed
    1. Japanese Gastric Cancer Association Japanese gastric cancer treatment guidelines 2010 (ver. 3) Gastric Cancer. 2011;14:113–123. - PubMed