Alimentary tract reconstruction after laparoscopic total gastrectomy is a technical challenge. Although feasible, reconstruction through a small incision has several drawbacks. The authors therefore report a modified method of laparoscopic side-to-side esophagojejunal anastomosis developed at their hospital.
The side to side esophagojejunal anastomosis was completed with a endo-GIA firing, followed by transection of the jejunum and esophagus with another firing of endo-GIA.
This modified procedure was performed successfully for 14 patients with gastric cancer. The mean operation time for this procedure was 42.5 ± 10.2 min. No postoperative death, fistula, or hemorrhage occurred. All the patients were followed up for a mean period of 14.5 months with no cancer recurrence at the anastomosis or anastomotic stricture. All the patients had a barium swallow test 6–2 months after the operation. The mean maximum diameter of the anastomosis was 3.8 cm (range, 3.0–4.2 cm). Four patients experienced temporary symptoms of dumping syndrome or dysphagia, which disappeared 6 months postoperatively.
The authors consider this modified laparoscopic side-to-side esophagojejunal anastomosis to be safe, less challenging, and more economical, providing an alternative for alimentary tract reconstruction after laparoscopic total gastrectomy.
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Asao T, Hosouchi Y, Nakabayashi T, Haga N, Mochiki E, Kuwano H (2001) Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer. Br J Surg 88:128–132
Mochiki E, Kamimura H, Haga N, Asao T, Kuwano H (2002) The technique of laparoscopically assisted total gastrectomy with jejunal interposition for early gastric cancer. Surg Endosc 16:540–544
Dulucq JL, Wintringer P, Perissat J, Mahajna A (2005) Completely laparoscopic total and partial gastrectomy for benign and malignant diseases: a single institute’s prospective analysis. J Am Coll Surg 200:191–197
The Japanese Gastric Cancer Association (2001) Guidelines for the treatment of gastric cancer. Kanehara-Shuppann, Tokyo
Takiguchi S, Sekimoto M, Fujiwara Y, Miyata H, Yasuda T, Doki Y et al (2005) A simple technique for performing laparoscopic purse-string suturing during circular stapling anastomosis. Surg Today 35:896–899
Gamal EM, Szabo G, Nagy P, Brath E, Peto K, Olah A et al (2005) The role of pneumoperitoneum and the “chimney effect” on the development of port site metastasis: a new experimental animal model using Furka’s spleen tissue suspension. Magy Seb JT Magyar Sebeszet 58:89–92
Walther BS, Zilling T, Johnsson F et al (1989) Total gastrectomy and oesophagojejunostomy with linear stapling devices. Br J Surg 76:909–912
Matsui H, Uyama I, Sugioka A et al (2002) Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy. Am J Surg 184:58–60
Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A (1999) Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 2:230–234
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Ziqiang, W., ZhiMin, C., Jun, C. et al. A modified method of laparoscopic side-to-side esophagojejunal anastomosis: report of 14 cases. Surg Endosc 22, 2091–2094 (2008). https://doi.org/10.1007/s00464-008-9744-z
- Alimentary tract reconstruction
- Esophagojejunal anastomosis
- Laparoscopic total gastrectomy
- Gastric cancer
- Minimally invasive surgery