Completely laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomy1

Uyama, Ichiro; Sugioka, Atsushi; Fujita, Junko; Komori, Yoshiyuki; Matsui, Hideo; Hasumi, Akitake

doi:10.1016/s1072-7515(00)00283-0

Cited by 52 publications

(41 citation statements)

References 9 publications

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“…However, LATG is not a popular procedure for proximal EGC in Korea and Japan because of the difficulties of creating an esophagojejunostomy under laparoscopy. The number of cases of LATG has been increasing in Korea (20 [3]. When considering the advantages of a minimally invasive surgery and functionpreserving procedures, LAPG is theoretically a better option than LATG.…”

Section: Discussionmentioning

confidence: 99%

“…To prevent reflux esophagitis, various esophagojejunostomy techniques after proximal gastrectomy have been studied, including jejunal interposition [20], in which a segment of the jejunum is interposed between the esophagus and the remnant stomach, and jejunal pouch interposition [21], in which a jejunal pouch is used instead. Katai and colleagues [22] reported the longterm results of jejunal interposition after proximal gastrectomy, and the incidence of reflux symptoms remained low (5.5 %), a similar finding to those of previous studies but a lower rate than that observed after other types of proximal gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

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Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer

et al. 2012

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Background The choice of surgical strategy for patients with proximal gastric cancer is controversial. The purpose of this study was to assess the feasibility, safety, and surgical and functional outcomes of laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG). Methods Between June 2003 and December 2009, 131 patients with proximal gastric cancer underwent LAPG (n = 50) or LATG (n = 81) at Seoul National University Bundang Hospital. We reviewed their medical and surgical records from our prospectively collected gastric cancer database. The clinicopathologic characteristics and shortterm, long-term, and functional outcomes were compared between the 2 groups. Results There were no significant differences in demographics, T-stage, N-stage, or survival between the 2 groups. The LAPG group had a shorter operative time and lower estimated blood loss than the LATG group. The early complication rates after the LAPG and LATG procedures were 24.0 and 17.3 %, respectively (p = 0.349). The incidence of reflux symptoms was significantly higher in the LAPG group (32.0 vs. 3.7 %, p \ 0.001). The parameters that reflected nutritional status were similar in the 2 groups. Conclusion LAPG is a feasible and acceptable method for treating proximal early gastric cancer in terms of surgical and oncologic safety. However, esophagogastrostomy after LAPG was associated with an increased risk of reflux symptoms. Antireflux procedures should be considered to prevent reflux symptoms after LAPG.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer

et al. 2012

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“…For earlystage proximal gastric cancer, proximal gastrectomy has been employed [1][2][3][4][5][6]. Although laparoscopic distal gastrectomy has recently been widely employed for early gastric cancer [9][10][11][12], reports of laparoscopic proximal gastrectomy are rare [8,13]. Such procedures are not performed frequently because laparoscopic esophagoenterostomy is technically difficult to perform.…”

Section: Discussionmentioning

confidence: 99%

“…The firing of the stapler converted the two holes into a single entry hole. The esophagus was transected, using the endoscopic stapling device remnants [8]. However, this procedure has not been indicated for patients with large gastric remnants, given the following considerations: (1) if jejunal interposition was to be performed for patients with large gastric remnants, postoperative observation of the gastric remnant by endoscopy would sometimes be difficult because of the tortuosity of the interposed jejunum; (2) the procedure is complicated and time-consuming, and requires many stapling devices; and (3) the proximal segment of the jejunum, which is important for nutrient absorption, is scarred by the procedure.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic side-to-side esophagogastrostomy using a linear stapler after proximal gastrectomy

et al. 2001

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trectomies in two patients with gastric cancer. Here, we describe our surgical procedure and the postoperative courses of these two patients. Surgical procedureEach patient was placed under general anesthesia in the supine, reverse Trendelenburg position with the legs apart. The surgeon stood on the patient's right, with the assisting surgeon on the patient's left, and the camera operator stood between the patient's legs. Pneumoperitoneum was then established, using an open technique, and five working ports (each 12 mm in diameter) were then placed.Laparoscopic mobilization and transection of the stomach, and lymphadenectomy (which consisted of a limited dissection A according to the new Japanese practice guidelines for gastric cancer) were performed by the same methods as those that we reported previously ( Fig. 1) [8]. In our procedure, in order to prevent pyloric stenosis, postoperative diarrhea, and an increased risk of cholelithiasis, the vagal pyloric, celiac, and hepatic branches were preserved. Accordingly, the esophagus was not transected until after anastomosis, to allow the esophagogastrostomy to be performed safely. Side-to-side esophagogastrostomyThis anastomosis involves attaching the posterior aspect of the esophagus to the anterior wall of the gastric remnant. There must be sufficient overlap so that 5-6 cm of esophagus will lie freely over the front of the gastric remnant. Therefore, the esophagus was sufficiently mobilized to allow this. The posterior wall of the esophagus was excised, and a 1-cm stab wound was made in the anterior wall of the gastric remnant, approximately 5-6 cm from the staple lines of the stump. A 45-mm endoscopic linear stapler (ETS45; Ethicon Endo-Surgery, AbstractIn order to improve anastomotic procedures, we performed laparoscopic side-to-side esophagogastrostomy, using a linear stapler, after proximal gastrectomy in two patients with gastric cancer located in the upper third of the stomach. The patients' postoperative courses were excellent. During postoperative recovery, the patients experienced very little pain, used no analgesic medications, and never experienced reflux esophagitis. This procedure is technically feasible and is an excellent option, given the less involved anastomotic procedure and better postoperative quality of life compared with these features in end-to-side anastomosis using a circular stapler.

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“…In contrast, intraabdominal anastomosis is unlikely to produce tension at the anastomotic site, and it is practicable under complete endoscopic guidance;, thus, there is no visual change, and it is an ideal technique for anastomosis. However, regardless of the various improvements reported recently [6,7], this technique (i.e., intraabdominal anastomosis) requires time to learn, as well as higher costs; thus, it is expected that it will take some time before the technique is commonly used.…”

Section: Discussionmentioning

confidence: 99%

“Tornado Roux-en-Y” anastomosis in laparoscopy-assisted distal gastrectomy

et al. 2008

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site and is thus recommended as a safe technique, although, because of its complicated procedure, surgical time may be prolonged. To solve this problem, we have employed a totally instrumental RY anastomosis, including jejunojejunostomy to gastrojejunostomy. We have been using the technique for 3 years, and each time we have achieved reconstruction safely in a short time. The details of the technique and the short-term results are described below. Methods Summary of the surgical techniqueOur technique is summarized in the diagrams in Fig. 1A-C. It is characterized by no incision of the jejunal mesentery, no initial cut of the jejunum, and by gastrojejunostomy and jejunojejunostomy being performed through a common entry hole. With this technique, we have achieved signifi cant time reduction by repeating the two simple anastomotic procedures. We named the technique "Tornado Roux-en-Y" because the jejunum is rotated during jejunojejunostomy. Surgical procedure1. The duodenum should be cut with the blue cartridge of a three-line end linear stapler (ELS). While B-I anastomosis requires the duodenum to be cut as closely to the stomach as possible to ensure an allowance for suture, RY anastomosis allows the duodenum to be cut at any point anal to the pyloric ring. 2. After completion of the resection, identify a site about 20 cm anal to the ligament of Treitz, and mark the site with dye, with the oral end positioned to the left of the patient and the anal end positioned to the right. This ensures that the jejunal end is positioned to the right with no kinks during the gastrojejunos- AbstractThe use of laparoscopy-assisted distal gastrectomy has been gradually spreading and it has become one of the standard treatment options for early gastric cancer in Japan. But anastomotic problems are still frequent with this procedure, because of its technical diffi culty. We have developed a simple, safe, and speedy Roux-en-Y anastomosis for use in laparoscopy-assisted distal gastrectomy. Here, we describe our technique and the short-term results.

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Completely laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomy1

Cited by 52 publications

References 9 publications

Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer

Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer

Laparoscopic side-to-side esophagogastrostomy using a linear stapler after proximal gastrectomy

“Tornado Roux-en-Y” anastomosis in laparoscopy-assisted distal gastrectomy

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