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Intra-corporeal hand-sewn esophagojejunostomy is a safe and feasible procedure for totally laparoscopic total gastrectomy: short-term outcomes in 100 consecutive patients

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Abstract

Background

An optimal method for intracorporeal esophagojejunostomy has not yet been standardized. This study sought to introduce intracorporeal hand-sewn end-to-side esophagojejunostomy after totally laparoscopic total gastrectomy.

Methods

The author conducted a consecutive series of 100 intracorporeal hand-sewn esophagojejunostomies after totally laparoscopic total gastrectomy for upper third gastric cancer from September 2012 to December 2016.

Results

All patients were successfully operated on without conversion to open- or laparoscope-assisted surgery. The mean reconstruction time was 45 min, and the time until first flatus was 4 days. The time to start a soft diet was 7 days. The length of postoperative hospital stay was 8 days. The overall postoperative morbidity was 8%, including one anastomotic leak, and the mortality was zero. The median follow-up duration was 13 months; no anastomotic strictures were encountered.

Conclusions

Intracorporeal hand-sewn end-to-side esophagojejunostomy after totally laparoscopic total gastrectomy is a safe and feasible procedure. This method can identify negative margins with intraoperative frozen sections before reconstruction and could be a good option for performing intracorporeal esophagojejunostomy with an advanced endoscopic suture technique.

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Acknowledgements

This study was supported by Project Grants of Zhejiang Provincial Department of health (Grant No. Y2015ZDA019) and Natural Science Foundation of Zhejiang Province (Grant No. Y15H160027 and No. Y15H160030). We appreciate the voice work for video by Alex Blair who worked at the department of HPB surgery, Johns Hopkins hospital.

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    Authors and Affiliations

    1. Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People’s Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China

      Xiaowu Xu, Chaojie Huang, Yiping Mou, Renchao Zhang & Chao Lu

    2. Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China

      Yu Pan

    3. School of Medicine, Zhejiang University, Hangzhou, 310029, Zhejiang, China

      Ke Chen

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    1. Xiaowu Xu
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    Correspondence to Yiping Mou.

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    Xiaowu Xu, Chaojie Huang, Yiping Mou, Renchao Zhang, Yu Pan, Ke Chen, and Chao Lu have no conflicts of interest or financial ties to disclose.

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    Xiaowu Xu and Chaojie Huang have contributed equally to this work.

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    Xu, X., Huang, C., Mou, Y. et al. Intra-corporeal hand-sewn esophagojejunostomy is a safe and feasible procedure for totally laparoscopic total gastrectomy: short-term outcomes in 100 consecutive patients. Surg Endosc 32, 2689–2695 (2018). https://doi.org/10.1007/s00464-017-5964-4

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