Laparoscopic hand-sewn esophagojejunal anastomosis in laparoscopic proximal gastrectomy for early gastric cancer



In Asian countries, proximal gastrectomy is a standard treatment option for early primary gastric cancer located in the upper third of the stomach. However, laparoscopic proximal gastrectomy (LPG) is not widely employed due to the technical difficulty of laparoscopic esophagojejunal anastomosis. Therefore, we began performing laparoscopic hand-sewn esophagojejunal anastomosis. In this report, we describe the technique of this method and the short-term surgical outcomes.


Between February 2016 and June 2020, 18 patients underwent LPG with double-tract reconstruction at our institution. Laparoscopic hand-sewn esophagojejunal anastomosis was attempted for all patients.


The median operative time for the 18 patients was 431 min (range: 301–549 min), and the estimated blood loss was 100 mL (range: 0–1524 mL). The median time for the hand-sewn esophagojejunostomy was 42 min (range: 26–81 min). Only one case was converted to open surgery after the reconstruction due to bleeding from an artery of the lesser curvature. No anastomotic leakage was observed in any patients (0/18, 0 %); however, two patients developed anastomotic stenosis (2/18, 11%). The mean length of postoperative hospital stay was 10 days (range: 8–28 days).


The laparoscopic hand-sewn esophagojejunal anastomosis in LPG is a simple, cost-effective, and safe procedure. We believe that our method is a feasible choice. However, careful and longer follow-up of more patients is necessary to determine the advantages of our method.

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All data generated or analyzed during this study are included in this published article.


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We would like to thank Editage ( for English language editing.

Author information




TK, KO, and MF designed this study. TK, JU, and MF collected the clinical information. TK and KO drafted this manuscript. NS, YA, JU, HS, EA, MO, HU, KK, and YS reviewed and edited the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Takayoshi Kishino.

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Kishino, T., Okano, K., Noge, S. et al. Laparoscopic hand-sewn esophagojejunal anastomosis in laparoscopic proximal gastrectomy for early gastric cancer. Langenbecks Arch Surg (2021).

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  • Gastric cancer
  • Laparoscopic hand-sewn esophagojejunal anastomosis
  • Double-tract reconstruction
  • Laparoscopic proximal gastrectomy
  • Surgical technique