Laparoscopic double-tract reconstruction after total gastrectomy for postoperative duodenal surveillance: Case series

Otsuka, Ryota; Hayashi, Hideki; Hanari, Naoyuki; Gunji, Hisashi; Hayano, Koichi; Kano, Masayuki; Matsubara, Hisahiro

doi:10.1016/j.amsu.2017.07.080

Cited by 9 publications

(4 citation statements)

References 10 publications

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“…[19][20][21] In the era of laparoscopic surgery, the problem of the best reconstruction technique after laparoscopic total gastrectomy has been widely discussed. Two meta-analyses 28,30 and one RCT. 29 demonstrated that IA is safer, with better cosmetic appearance, technically more feasible, leads to faster recovery of intestinal function, is less invasive compared to EA.…”

Section: Discussionmentioning

confidence: 99%

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Reconstruction of the gastrointestinal tract after total gastrectomy

Pavlov¹

2019

GHOA

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Currently, there are more than 70 types of restoration of gastrointestinal tract (GIT) continuity. Reconstruction of the digestive tract is an important part of surgery on par with lymph node dissection and it must have the following characteristics: gradual emptying into the small intestine, prevention of reflux esophagitis and dumping syndrome, small reservoir size, and reconstructive operative procedures should be relatively uncomplicated and not time-consuming. The technique of GIT reconstruction is the determining factor of postoperative quality of life for the patients. According to the Japanese guidelines, there're two types of reconstruction: with preservation of the duodenal passage and without it. The most known techniques in the duodenal passage exclusion group are Roux-en-Y reconstruction and Roux-en-Y reconstruction with pouch formation. In the duodenal passage preservation group interposition of the jejunum with and without pouch formation are the most common. Currently, Roux-en-Y reconstruction is the preferred technique. The use of Roux-en-Y reconstruction with a pouch to recover the initial anatomical structure significantly decreases the incidence of dumping syndrome and doesn't increase the number of postoperative complications or mortality, operative time, hospitalization time, and significantly increases patients' quality of life. For laparoscopic total gastrectomy, it was shown that intracorporeal anastomosis has a better cosmetic appearance, it's safer, technically feasible, less invasive compared to the extracorporeal anastomosis. Reconstruction using the OrVil device should be used in patients with tumors of the cardia or lower third of the esophagus because anastomosis can be formed high in the mediastinum which increases the probability of negative proximal resection margin after gastrectomy.

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Section: Discussionmentioning

confidence: 99%

“…Zheng et al 28 in a meta-analysis had shown that IA is characterized by better appearance, lower blood loss and faster recovery of intestinal function. In RCT 29 and meta-analysis 30 of 2015, LTG with IA was reported to be safer and more technically feasible that LTG with EA.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of the gastrointestinal tract after total gastrectomy

Pavlov¹

2019

GHOA

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“…This leads to favorable weight maintenance and nutritional outcomes for these patients [ 19 , 20 ]. Preservation of the duodenal passage in gastric reconstruction procedures may also be beneficial for access to the hepatobiliary system after surgery, in patients requiring Endoscopic Retrograde Cholangiopancreatography (ERCP) for various reasons post surgically [ 8 , 21 ].…”

Section: Effect On Postoperative Complicationsmentioning

confidence: 99%

A review on double tract reconstruction after proximal gastrectomy for proximal gastric cancer

Lewis

Dong

2022

Annals of Medicine &Amp; Surgery

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confidence: 99%

Totally Laparoscopic Total Gastrectomy with Oesophagus-Duodenal Interposition of a Pedicled Jejunal Flap in a Patient with Familial Adenomatous Polyposis (with video)

Barbosa¹,

Sousa²,

Batista³

et al. 2022

SGO

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Introduction: Several interposition techniques have been described for reconstruction after total gastrectomy in FAP patients, in open (1) and laparoscopic assisted surgery (2,3,4). The Longmire technique has the advantage of allowing all the food to pass through the duodenum and better absorption of nutrients, such as iron (5). Here, we describe the use of a pedicled isoperistaltic jejunal flap interposition technique to reconstruct the digestive tract after total gastrectomy, fully performed by laparoscopic approach, in a patient with FAP that had previous total colectomy. Our patient was a 68-year-old woman, with "MUTYH-Associated Polyposis (MAP)", a c.494A>G mutation at exon 7 and c.1145G>A mutation at exon 13. She was diagnosed with gastric cancer and lesions of high-and low-grade dysplasia. She was previously submitted to a laparoscopic total colectomy, 2009, and a conservative breast surgery plus chemoradiotherapy in 2017. She also had duodenal and rectum polyps in her surveillance exam. Surgical technique: Five access ports were used. We performed a standard total gastrectomy with D2 lymphadenectomy. The reconstructive phase of the surgery started with the selection of a jejunal loop, 50 cm after the Treitz ligament, which was sectioned, in order to enable an oesophagojejunal anastomosis. The jejunal loop was connected to the duodenum through a side-to-side anastomosis with a linear endo stapler. This created an isoperistaltic conduit with the required extension for a tension-free anastomosis. Afterwards, the jejunal loop was sectioned immediately distally to the jejunoduodenal anastomosis and digestive continuity was restored with a side-to-side jejunojejunal anastomosis. Operative time was 4 hours and 7 minutes. Blood loss was less than 150 mL. No intraoperative or postoperative complications occurred. The patient was discharged on the seventh post-operative day. She has been on follow-up as an outpatient for seven

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Laparoscopic double-tract reconstruction after total gastrectomy for postoperative duodenal surveillance: Case series

Cited by 9 publications

References 10 publications

Reconstruction of the gastrointestinal tract after total gastrectomy

Reconstruction of the gastrointestinal tract after total gastrectomy

A review on double tract reconstruction after proximal gastrectomy for proximal gastric cancer

Totally Laparoscopic Total Gastrectomy with Oesophagus-Duodenal Interposition of a Pedicled Jejunal Flap in a Patient with Familial Adenomatous Polyposis (with video)

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