Minimum Leakage Rate (0.5%) of Stapled Esophagojejunostomy with Sacrifice of a Small Part of the Jejunum after Total Gastrectomy in 390 Consecutive Patients

Abstract

Background: The development of new surgical instruments and devices has facilitated the performance of esophagojejunostomy after total gastrectomy. However, total prevention of dehiscence of anastomoses remains difficult. We introduced a new procedure for esophagojejunostomy using a circular stapler, requiring sacrifice of only a small part of the jejunum. Methods: The study group comprised 390 consecutive patients who underwent reconstruction by Roux-en-Y esophagojejunostomy, performed with a circular stapler, sacrificing a small part of the jejunum after total gastrectomy. We assessed anastomotic leakage and anastomotic stenosis after surgery. Results: Only 2 patients (0.5%) had leakage and 4 (1.0%) had anastomotic stenosis after reconstruction. All the patients were cured by conservative therapy. Conclusions: Esophagojejunostomy performed with a circular stapler after total gastrectomy, with sacrifice of only a small part of the jejunum, is a useful and easy procedure, with a leakage rate of 0.5%.

Significance of intraoperative endoscopy in total gastrectomy for gastric cancer

“…However, anastomotic leakage following gastrointestinal surgery still occurs, and some leakages are clinically significant. In particular, anastomotic leakage after total gastrectomy for gastric cancer is not uncommon, and the incidence of such a complication ranges from 0.5 to 11% [1][2][3][4]. Anastomotic leakage is associated with high morbidity and mortality and a lower survival rate [5].…”

Can the intraoperative leak test prevent postoperative leakage of esophagojejunal anastomosis after total gastrectomy?

“…For these cases, other causes of EJAL other than physical dehiscence can be considered, such as the presence of tension on the anastomosis [10]. However, our leakage rate (4.9 %) was not satisfactory compared to the average leakage rate (4.4 %) in Japan [12].…”

“…Surgical resection with lymphadenectomy is the only curative treatment. Although there have been recent improvements in the surgical techniques and perioperative management, esophagojejunal anastomotic leakage (EJAL) is still one of the most serious complications after total gastrectomy, and the reported incidence of EJAL varies between 0.5 and 11.0 % [2][3][4][5][6][7][8][9][10][11][12][13]. EJAL leads to a poorer quality of life, prolonged hospital stay, and increased costs and mortality [3,5,6,14].…”

Postoperative Probleme nach Magenresektion oder Gastrektomie und Pankreasresektion

“…Eine Leckage der Ösophagojejunostomie nach (erweiterter) Gastrektomie tritt in einer Häufigkeit bis zu 15% auf, wobei die Inzidenz in erfahrenen Zentren deutlich unter 10% gesenkt werden konnte [7,16,18]. Trotzdem stellt diese Komplikation weiterhin die häufigste Ursache der postoperativen Letalität dar, die bis zu 40% betragen kann.…”