Intracorporeal esophagojejunostomy using the hemi-doublestapling technique (HDST) after laparoscopic total gastrectomy in gastric cancer patients

Bandar Ali, MD. The catholic university of Korea, Seoul St.Mary’s hospital

Purpose: To present technique proposed by the author with its technical details on reconstruction with HDST, feasibility and safety of circular stapling technique during esophagojejunostomy in totally gastrectomized gastric cancer patients.

Methods: A retrospective case-series study between July 2010 and December 2014, 58 consecutive patients with gastric cancer underwent laparoscopic assisted total gastrectomy (LATG) in Seoul St. Mary’s hospital were enrolled for study. We performed a simple and safe Roux-en-Y esophagojejunostomy using hemi-double stapling technique (HDST). All patients’ characteristics, perioperative outcome and histopathologic data were reviewed.

Results: The mean age and body mass index were 57.3 ± 9.7 years and 23.7 ± 2.6 kg/m2 respectively. The mean overall total operation including reconstruction and anvil insertion times were 199.8 ± 57.0 min. Intra operative blood loss was 81.6 ± 56.3 mL and there was no open conversion. Splencetomy was needed initially in only 2 patients (3.4%). The postoperative complications divided to EJ anastomosis site and non EJ anastomosis site. In EJ site was 5(8.6%) cases of leak were all controlled successfully by endoscopic stent, 3(5.1%) cases of anastomosis stricture were treated all successfully by endoscopic intervention except for 1(1.7%) case needed surgical intervention. A-loop partial obstruction was encountered in 3(5.1%) cases were treated conservatively, 1(1.7%) case of A-loop bleeding was treated conservatively as well. Non EJ site complication in majority was chest related complications i.e. pneomnia in 3(5.1%) cases, pleural effusion in 4(6.8%) cases, pancreatitis in 2(3.4%) cases, splenic bleeding in 1 case necessitated splenectomy to control bleeding. Intra abdominal fluid collection was in 6(10.3%) cases, wound infection in 2(3.4%) case, wound disruption in 1(1.7%) cases, ileus in 5(8.6%) cases and trocar site hematoma in 1(1.7%) case. The patients were hospital stay at a mean of 9.6 ± 2 days. The mean proximal margin of specimen was 2.7 ± 1.8 cm.

Conclusion: Roux-en Y esophagojejunostomy using method of circular hemi double stapling technique is simple, safe and rapid. It may offer a solid, alternative reconstruction method in totally gastrectomized patients.

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