Introduction: Simple and secure technique of reconstruction is necessary to facilitate acceptance of laparoscopic total gastrectomy for gastric cancer patients. We use a modified functional end-to-end anastomosis technique and make esophagojejunostomy using linear staplers without hand sewing. After experiences of reconstructions with an extra-corporeal method, we perform anastomosis mostly by an intra-corporeal method.
Patients: All patients were diagnosed with gastric cancer, which was located in the upper third of the stomach without lymph node involvement nor invasion to the esophagus.
Procedures: A) In the extra-corporeal method, after mobilization of stomach and lymph node dissection was completed, a 5-cm midline skin incision was made in the upper abdomen. Through the wound, Y-anastomosis was performed using ETS-FLEX 45 to create a 50-cm Roux-en-Y limb. The stomach was pulled out from the minilaparotomy and holes are made in the left side of the esophagus. The Roux-en-Y limb was then brought up via the antecolic route and a small hole was made at its end on the anti-mesenteric side. ETS-FLEX45 was applied through the mini-laparotomy with one jaw in each hole to make a side-to-side esophagojejunal anastomosis. To complete the closure and transect the esophagus to finish the gastrectomy concurrently, ETS-FLEX 45 was applied through the left lower trocar under direct vision through the laparotomy. B) In the intra-corporeal method, gastrectomy was completed by the transection of the esophagus first. The umbilical trocar wound was extended to take out the stomach and the Y-anastomosis was created through the wound. ETS-FLEX 45 was applied through the left lower trocar to create side-to-side anastomosis between the left side of the esophagus and the jejunal limb. After the entry hole was roughly closed with hernia staplers, ETS-FLEX 45 was applied through the right lower trocar so that all hernia staplers were removed and the closure was completed.
Results: We performed esophagojejunal anastomosis extracorporeally in seven patients and intracorporeally in ten patients. We experienced neither stenosis nor leakage of the anastomosis. All patients resumed intake of clear liquid on the third postoperative day and ingested food on the following day. The median postoperative hospital stay was 11 days.
Conclusions: Linear stapled esophagojejunostomy is a secure and feasible method for reconstruction after laparoscopic total gastrectomy.
Program Number: P252