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

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Availability of data and materials

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

References

  1. 1.

    Kusano C, Gotoda T, Khor CJ, Katai H, Kato H, Taniguchi H, Shimoda T (2008) Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in a large tertiary referral center in Japan. J Gastroenterol Hepatol 23:1662–1665

    Article  Google Scholar 

  2. 2.

    Wu H, Rusiecki JA, Zhu K, Potter J, Devesa SS (2009) Stomach carcinoma incidence patterns in the United States by histologic type and anatomic site. Cancer Epidemiol Biomark Prev 18:1945–1952

    Article  Google Scholar 

  3. 3.

    Steevens J, Botterweck AA, Dirx MJ, van den Brandt PA, Schouten LJ (2010) Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur J Gastroenterol Hepatol 22:669–678

    PubMed  Google Scholar 

  4. 4.

    Dassen AE, Lemmens VE, van de Poll-Franse LV, Creemers GJ, Brenninkmeijer SJ, Lips DJ, Vd Wurff AA, Bosscha K, Coebergh JW (2010) Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990 and 2007: a population-based study in the Netherlands. Eur J Cancer 46:1101–1110

    CAS  Article  Google Scholar 

  5. 5.

    Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20(1):1–19

  6. 6.

    Katai H, Mizusawa J, Katayama H, Morita S, Yamada T, Bando E, Ito S, Takagi M, Takagane A, Teshima S, Koeda K, Nunobe S, Yoshikawa T, Terashima M, Sasako M (2020) Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol 5:142–151

    Article  Google Scholar 

  7. 7.

    Inokuchi M, Otsuki S, Fujimori Y, Sato Y, Nakagawa M, Kojima K (2015) Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy. World J Gastroenterol 21:9656–9665

    Article  Google Scholar 

  8. 8.

    Wang WP, Gao Q, Wang KN, Shi H, Chen LQ (2013) A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg 37:1043–1050

    CAS  Article  Google Scholar 

  9. 9.

    Fukagawa T, Gotoda T, Oda I, Deguchi Y, Saka M, Morita S, Katai H (2010) Stenosis of esophago-jejuno anastomosis after gastric surgery. World J Surg 34:1859–1863

    Article  Google Scholar 

  10. 10.

    Wang X, Li Y, Cai Y, Meng L, Cai H, Liu X, Peng B (2018) Laparoscopic suture training curricula and techniques. Ann Transl Med 6:215

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank Editage (www.editage.com) for English language editing.

Author information

Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Takayoshi Kishino.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethics approval

Not applicable

Consent for publication

Informed consent was obtained from all individual participants included in this study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1007/s00423-021-02104-0

Download citation

Keywords

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