Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: A single-center 7-year experience

Abstract

AIM:To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy (LTG) for gastric cancer. METHODS:A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records. RESULTS:The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 mL. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%. Observational Study ORIGINAL ARTICLEHowever, there were no cases of postoperative death.CONCLUSION: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness.

Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matched study

“…One investigator reported that the use of circular staplers is associated with EJS leakage [28], but another found the incidence of EJS leakage was similar regardless of stapler type (linear vs. circular) [17]. Chen et al suggested that the use of a circular or linear stapler for EJS is feasible and safe and recommended that the EJS method should be selected on the basis of the tumor location [19].…”

“…On the other hand, laparoscopic total gastrectomy (LTG) is much less frequently performed than laparoscopic distal gastrectomy (LDG) because the subsequent esophagojejunostomy (EJS) is technically difficult. While several studies have evaluated the safety of LTG [12][13][14][15][16][17][18][19], only a few have examined long-term outcomes [20][21][22]. A study to validate the safety of minimally invasive EJS is ongoing in Japan [23], but there is no RCT investigating short-or long-term outcomes after LTG for GC.…”

Two-Layer Hand-Sewn Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy for Gastric Cancer

“…Several EJ methods have proven to be safe and feasible [ 13 15 16 17 18 19 ]. However, comparisons of different EJ techniques are difficult due to the lack of comparative trials and the low rate of EJ leak [ 20 ]. The best method of laparoscopic EJ should be determined in a randomized controlled trial; however, it is unlikely that such a study will be performed in the near future.…”

Survey on laparoscopic total gastrectomy at the 11th China‐Korea‐Japan Laparoscopic Gastrectomy Joint Seminar

“…To perform this anastomosis extracorporeally, a vertical subxiphoid mini‐laparotomy with enough length is indispensable . Although intracorporeal E‐J stomy has been proven to be feasible and have reasonable short‐term outcomes , its application prospects in China are doubtful because of the extra cost of special devices (e.g. OrVil TM ).…”