Outcome of functional end-to-end esophagojejunostomy in totally laparoscopic total gastrectomy

Abstract

PurposeTotally laparoscopic total gastrectomy (TLTG) is unpopular because reconstruction is difficult. In fact, esophagojejunostomy is the most difficult surgical technique in TLTG. We adopted functional end-to-end anastomosis for esophagojejunostomy to simplify the procedure. The present study assesses the feasibility and surgical outcomes of TLTG with functional end-to-end esophagojejunostomy.MethodsWe assessed the intraoperative and postoperative outcomes of 65 consecutive patients who underwent TLTG with functional end-to-end esophagojejunostomy at Tonan Hospital between January 2006 and August 2011.ResultsThe mean surgical duration was 271.5 ± 64.7 min, and the mean blood loss was 85.2 ± 143.2 g. One patient (1.5 %) was converted to open surgery, and two patients (3.1 %) required reoperation due to ileus because of an internal hernia and jejunojejunostomy leakage. No reoperation was associated with functional end-to-end esophagojejunostomy. The mean hospital stay was 21.4 ± 13.5 days. Ten patients (15.4 %) developed postoperative complications, of which three (4.6 %) were anastomotic stenosis associated with functional end-to-end esophagojejunostomy. All of these were resolved by endoscopic dilation.ConclusionFunctional end-to-end esophagojejunostomy in TLTG is safe and feasible.

Application of reduced-port laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen

“…This also suggested that the long-term survival for these patients may be expected to be equivalent in the two groups, although follow-up studies are needed to confirm this. Some previous studies have shown that totally laparoscopic total gastrectomy (TLTG) using either functional end-to-end esophagojejunostommy or OrVil TM reconstructions is an acceptable surgical procedure [20,21]. Blood losses and postoperative morbidities in these studies were similar to those in our study, although our operation times were longer than those in the TLTG studies.…”

Laparoscopic Total Gastrectomy for Gastric Cancer

“…[19][20][21][22][23][24][25][26][27][28][29] However, there were no differences in the surgical outcomes between extracorporeal and intracorporeal E-J stomy or between circular and linear stapling. The rate of E-J leakage ranged from 0% to 7.4% overall, from 1.5% to 7.4% for circular stapling, [14][15][16][17][18][19][20][21] and from 0% to 6% for linear stapling.…”

A systematic review of laparoscopic total gastrectomy for gastric cancer

“…Two types of esophagojejunostomy have been reported using linear staplers, a functional end-to-end anastomosis [35][36][37][38] and a side-to-side anastomosis (or the overlap method) [39][40][41][42][43]. The functional end-to-end procedure is performed by inserting the linear stapler into the esophagus thorough a small hole on the left side of the esophageal stump and simultaneously lifting the jejunum to insert the stapler through a small hole on the opposite side of the jejunum mesenterium.…”