Intracorporeal hand-sewn EJA during LTG for gastric cx

Rodrigo Munoz, MD, PhD1, Enrique Norero, MD2, Manuel Manzor, MD1, Eduardo Briceno, MD2, Mauricio Gabrielli, MD1, Nicolas Quezada, MD1, Marco Ceroni, MD3, Paulina Gonzalez, RN3, Fernando Crovari1. 1Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, 2Department of Digestive Surgery, Pontificia Universidad Catolica de Chile/Hospital Sotero del Rio, 3Department of Digestive Surgery, Hospital Sotero del Rio

Introduction: Laparoscopic total gastrectomy (LTG) to treat gastric cancer has gained popularity over the recent years due to its benefits associated with a minimally invasive approach, and due to its oncological results comparable to those observed after open total gastrectomy. However, performing the esophagojejunal anastomosis (EJA) is technically difficult and remains a major source of serious postoperative complications, such as leakage.

Objectives: To describe the surgical technique and report our preliminary experience with a new method of EJA for the reconstruction after LTG for gastric cancer.

Methods: We identified patients that underwent laparoscopic total gastrectomy for gastric cancer in two centers from 2012-2015, with a standard esophagojejunal anastomosis technique. Briefly, our reconstruction technique consisted of a Roux-en-Y, with a two layer intracorporeal hand-sewn EJA anastomosis using a 34Fr or 50Fr Bougie. An upper GI series study was performed to rule out leakage before the beginning of enteral feeding.

Results: We identified 41 patients, 21 (51.2%) were female, with an average age of 62 ± 12 years. The average operation time and EJA was 338 ± 64 minutes, 53 ± 16 minutes, respectively. Average intraoperative bleeding was 196 ± 129 ml. There were no conversions related to intracorporeal EJA. There were no patients with Clavien III or higher complications. Postoperative morbidity was observed in three (7,3%) patients. There was no mortality and no reoperations. Median length of stay was 8.5 (7-29) days. There were two (4,9%) cases of EJA leakage.

Conclusions: Intracorporeal hand-sewn esophagojejunostomy appears to be a safe and a technically feasible technique without the use of mechanical suturing devices. This technique also avoids the need of any upper abdominal incision, thus maintaining the benefits of minimally invasive approach.

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