Background: The technique of esophagojejunostomy in totally laparoscopic total gastrectomy is difficult and had a high frequency of incidents during surgery and anastomotic leakage. We aimed to evaluate the outcomes of the technique of functional end-to-end esophagojejunostomy by linear stapler without previous resection of the esophagus and jejunum in the totally laparoscopic total gastrectomy with D2 lymph node dissection in the treatment of gastric cancer.Methods: A prospective observational study on patients received technique of functional end-to-end esophagojejunostomy by linear stapler without previous resection of esophagus and jejunum between July 2017 to July 2020.Results: We included 70 patients with a mean age of 62.5. There were 80% of patients having tubular adenocarcinoma and papillary adenocarcinoma, 11.4% of patients having tumors in the upper third of the stomach, and 81.4% of patients having tumors in the middle of the stomach. There were 4.2% of cases having incidents during the surgery and 2.8% of cases having complications after the surgery. No anastomotic leakage or death was observed after the surgery. The mean lymph node was 23, and the mean metastatic lymph node was 2.7. The operation time was 203.8 minutes. The mean hospital stay was 8.0 days. The one year survival after the surgery was 97.9%, and two year survival was 93.1%. The mean survival was 35.3 months.Conclusions: TLTG with D2 lymph node dissection using functional end-to-end esophagojejunostomy by linear stapler without previous resection of esophagus and jejunum was safe and effective in gastric cancer treatment.

Background Spontaneous gas-forming pyogenic liver abscess (GFPLA) is a rare complication with a high fatality rate in spite of aggressive management. Clinical spectrum of GFPLA can mimic hollow viscus perforation as it usually accompanied by pneumoperitoneum and peritonitis. Up to now, GFPLA has not been well studied in Vietnam. Case presentation We reported here a case with pneumoperitoneum caused by ruptured liver abscess in a 41-year-old man with a history of treated duodenal ulcer and uncontrolled type II diabetes mellitus. He had an epigastric pain associated with a high fever. Patient was diagnosed peritonitis and pneumoperitoneum presumed to be secondary to perforation of a hollow viscus and subjected to emergency laparotomy. We did not find any gastrointestinal perforation. Surprisingly, we detected a 4 cm × 4 cm pus-containing abscess in the left liver lobe of the liver. The abscess was ruptured. Pus was running into abdominal cavity through one hole. The abscess and abdominal cavities were cleaned up and abscess and abdominal drainages were performed. K. pneumoniae was isolated from culture of the abscess. The histopathological examination of the abscess did not yield any evidence of malignancy. Blood glucose levels were controlled. Antibiotic therapy was used according to antibiogram. A reassessment chest X-ray showed no air-fluid level or subdiaphragmatic air by the hospital day 14. Patient eventually made a full recovery and was discharged home 23 days after the operation. Conclusions Ruptured GFPLA is a life-threatening complication. It is usually accompanied by peritonitis and pneumoperitoneum and can imitate hollow viscous perforation. In these cases, CT scan should be performed whenever it is possible to make a correct diagnosis. When the abscess has small size, partial hepatectomy might not be necessary and could be replaced by a careful cleaning and drainage of the abscess. Patient could show a good postoperative recovery following an appropriate antibiotic therapy.

Objective: To evaluate the outcomes, safety and effectiveness of laparoscopic total gastrectomy with D2 lymph node dissection with left-site surgeon and resection-closure of the duodenal stump in final phase after making esophageal anastomosis in gastric cancer treatment. Method: Prospective, descriptive study on patients undergoing laparoscopic total gastrectomy and D2 lymphadenectomy with left-site surgeon and resection-closure of the duodenal stump in final phase after making esophageal anastomosis in gastric cancer treatment from 06/2016-03/2020. Results: There were 70 patients in the study. The mean age was 59.9 years old, with a male/female ratio of 4/1. ASA 1 and 2 accounted for 97.2% of patients. The average lesion size was 3.4 cm. In total, 78.6% of patients had adenocarcinoma; 15.7% cases had tumour sites found in the upper third of the stomach, and 75.7% were found in middle third of stomach; 4.3% of cancers were at stage IA, 11.4% at IB, 32.9% at IIA, 30% at stage IIB, 7.1% at IIIA, 11.4% IIIB and 2.9% IIIC; 100% patients received laparoscopic total gastrectomy and D2 lymph node dissection with left-site surgeon and posterior duodenectomy; 4.2% had minor complications during surgery, and 2.8% developed complications after surgery; no deaths occurred during and after surgery. The average number of retrieved lymph nodes was 21.5 nodes, the average number of metastatic lymph nodes was 2.6, and the lymph node station numbers 1, 2, 3, 4 and 7 had high rates of metastases. The mean surgical time was 206.8 minutes, and the mean hospital stay was 8.8 days. The mean overall survival was estimated as 43.8 months. Conclusion: Laparoscopic total gastrectomy with D2 lymphadenectomy with left-site surgeon and final resection and closure of the duodenal stump demonstrated its safety and effectiveness in gastric adenocarcinoma treatment with less pain for patients, earlier movement recovery and lower hospitalization time.