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Observational Study
. 2016 Mar 28;22(12):3432-40.
doi: 10.3748/wjg.v22.i12.3432.

Intracorporeal Esophagojejunostomy After Totally Laparoscopic Total Gastrectomy: A Single-Center 7-year Experience

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Free PMC article
Observational Study

Intracorporeal Esophagojejunostomy After Totally Laparoscopic Total Gastrectomy: A Single-Center 7-year Experience

Ke Chen et al. World J Gastroenterol. .
Free PMC article

Abstract

Aim: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy (LTG) for gastric cancer.

Methods: A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records.

Results: The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 mL. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%. However, there were no cases of postoperative death.

Conclusion: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness.

Keywords: Esophagojejunostomy; Gastric cancer; Hand-sewn; Laparoscopy; Total gastrectomy.

Figures

Figure 1
Figure 1
Conventional circular stapler-anvil method. A: The purse-string suture (white arrow) was placed in the esophagus; B: The anvil was introduced into the esophageal stump through the hole; C: The circular stapler was introduced into the jejunum through the jejunal stump and attached with the anvil; D: The circular stapler was fired and the esophagojejunostomy was completed.
Figure 2
Figure 2
Linear stapler side-to-side method. A: Each jaw of the linear stapler was inserted into the holes on the esophageal stump and the jejunum and then the linear stapler was fired; B: The entry hole and esophagus were closed using the stapler.
Figure 3
Figure 3
Linear stapler delta-shaped method. A: Small holes were created along the edge of the esophageal stump and the jejunum that were approximated and joined with the endoscopic linear stapler; B: Stay sutures (white arrow) were placed to lift the common opening; C: The common opening was then closed with two applications of the linear stapler; D: Reconstruction of the intracorporeal alimentary tract was completed.
Figure 4
Figure 4
Hand-sewn end-to-side method. A: The jejunum was anchored to the esophageal stump by several serosal muscularis interrupted sutures placed in the posterior layer of the esophageal stump; B: The posterior wall was closed by several full-thickness interrupted sutures; C: Closure of the anterior wall was carried out by a full-thickness continuous suture; D: The seromuscular layer was strengthened with interrupted sutures to reduce tension.

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