Evaluation of Esophagogastrostomy Using a Circular Stapler in Laparoscopy-Assisted Proximal Gastrectomy

Daisuke Ichikawa, MD, Shuhei Komatsu, MD, Kazuma Okamoto, MD, Atsushi Shiozaki, MD, Hitoshi Fujiwara, MD, Yasutoshi Murayama, MD, Yoshiaki Kuriu, MD, Hisashi Ikoma, MD, Masayoshi Nakanishi, MD, Toshiya Ochiai, MD, Yukihito Kokuba, MD, Eigo Otsuji, MD. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine

 

Purpose: Recently, the frequency of early gastric cancer in the upper third of the stomach has especially increased. We have improved the esophagogastrostomy procedure to maximize the preservation of physiologic functions.
Methods: Fourteen patients were reconstructed by esophagogastrostomy with an incision in the left abdomen after limited proximal gastrectomy. We presented here the details of this reconstructive method, and demonstrated the results of postoperative evaluations of the lower esophagus and the remaining stomach. We also assessed quality of life in these patients using questionnaires, based on comparisons with that of patients underwent open limited proximal gastrectomy.
Results: Median surgical duration and blood loss was 315 min and 31 ml for this procedure. The approach using circular stapler from the left side allowed a good laparoscopic visual field to be obtained for plane of the esophagogastrostomy. The reconstructive procedure was successfully performed without intra-operative complications. There were no anastomosis-related postoperative complications encountered in ten patients, but delayed anastomotic stenosis occurred in one patient. This technique preserved the lower esophageal sphincter as well as peristalsis of the lower stomach, and also allowed the greater curvature near the top of the stomach to function as a new fundus. The incidence of reflux esophagitis on endoscopic examination was limited. There was no significant difference in the frequency of postoperative abdominal symptoms between the laparoscopic and open groups on the Gastrointestinal Symptom Rating Scale questionnaire.
Conclusions: This approach for esophagogastrostomy with an incision in the left abdomen could be a simple, easy and safe reconstructive technique after laparoscopy-assisted proximal gastrectomy with preservation of maximal physiologic function of the remnant stomach.


Session Number: Poster – Poster Presentations
Program Number: P232
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