J Minim Invasive Surg.  2012 Jun;15(2):32-37. 10.7602/jmis.2012.15.2.32.

Intracorporeal End-to-Side Esophagojejunostomy Using a Laparoscopic Purse-String Clamp during Laparoscopic Total Gastrectomy

• Noh SY
• Lee JH
• Ahn SH
• Son SY
• Lee CM
• Park DJ
• Kim HH
• Lee HJ
• Yang HK

• KMID: 1439183
• DOI: http://doi.org/10.7602/jmis.2012.15.2.32

Abstract

PURPOSE
Because no effective methods for performance of anastomosis have been established, use of laparoscopic total gastrectomy (LTG) has not been widely accepted. We aimed to establish the feasibility of using a newly developed purse-string suture instrument ("Lap-Jack"), which can be used in performance of intracorporeal anastomosis.
METHODS
From April, 2010 to February, 2011, 50 patients with upper gastric cancer underwent LTG with intracorporeal Roux-en-Y esophagojejunostomy using the Lap-Jack. Retrospective data for gender, age at the time of surgery, past medical history, operative time, estimated blood loss, TNM staging, and postoperative complications were reviewed.
RESULTS
Among the 50 patients, 33 were male and 17 were female. Median age was 59.9 years. The average operative time was 217.4+/-41.7 minutes. Based on the AJCC 7th edition of Gastric Cancer Staging, 19 patients were stage IA, three patients were IB, 12 patients were II, one patient was IIIA, three patients were IIIB, eight patients were IIIC, and two patients were IV. The overall morbidity rate was 18.0% without any mortality. Complications included wound problems (2.0%, n=1), pleural effusion (2.0%, n=1), urinary retention (4.0%, n=2), efferent loop obstruction due to adhesion (4.0%, n=2), postoperative ileus (2.0%, n=1), postoperative bleeding (2.0%, n=1), and intra-abdominal abscess (2.0%, n=1). No leakage or stenosis of esophagojejunostomy was reported.
CONCLUSION
The Lap-Jack is feasible and suitable for use in performance of esophagojejunostomy during LTG.

Keyword

Laparoscopic total gastrectomy (LTG); Intra-corporeal esophagojejunostomy; Purse-string clamp; Gastric cancer

MeSH Terms

Abdominal Abscess
Constriction, Pathologic
Female
Gastrectomy
Hemorrhage
Humans
Ileus
Male
Neoplasm Staging
Operative Time
Pleural Effusion
Postoperative Complications
Retrospective Studies
Stomach Neoplasms
Sutures
Urinary Retention