Intracorporeal esophagojejunostomy by hand-sewn suture under view of laparoscopy during total laparoscopic total gastrectomy: primary result of 34 cases

Yiping Mou, MD, FACS, Xiaowu Xu, MD, Ke Chen, Yu Pan, Yucheng Zhou, Di Wu. Sir Run Run Shaw Hospital, Zhejiang University

Background: Although laparoscopic surgery is more and more frequently performed for the treatment of gastric cancer, total laparoscopic total gastrectomy (TLTG) is not widely performed because of its technical dif?culty in intracorporeal esophagojejunostomy. Most of the intracorporeal esophagojejunostomy are performed with end-end anastomosis (EEA) or endoscopic liner stapler. We developed an intracorporeal esophagojejunostomy just by hand-sewn suture under view of laparoscopy, here we evaluated it’s safety and ef?cacy.

Methods: From September 2012 to September 2014, 34 consecutive patients with upper and middle gastric cancer underwent TLTG using this intracorporeal esophagojejunostomy by the same surgical term. This procedure is performed after transection of the abdominal esophagus with endoscopic liner stapler, the sample was sent to frozen examination ensuring the margin is negative. Then, the jejunum was transected and the distal jejunal loop was brought up to reach the esophageal stump. The jejunum was anchored to the esophageal stump by several serosal muscularis interrupted sutures placed to the posterior layer of the esophageal stump. The esophageal stump was opened again and a similar size incision was made on the anti-mesenteric side of the jejunum. Then full-thickness continuous suture for the posterior wall and the anterior wall was carried out under view of laparoscopy.

Results: The mean operation time of TLTG was 241.5 minutes, the mean anastomotic time was 43.2 minutes. There was no case conversion to an open procedure. The ?rst ?atus was observed at 3.5 days, and liquid diet was started at 4.6 days, and the mean postoperative hospital stay was 9.5 days. No postoperative complications related to anastomosis occurred.

Conclusions: Esophagojejunostomy by hand-sewn suture under view of laparoscopy can be performed safely by experienced laparoscopic surgeon. It has the advantages of cheap and safe because of suture under direct view of laparoscopy.

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