J Gastric Cancer.  2017 Sep;17(3):267-276. 10.5230/jgc.2017.17.e26.

Two-Layer Hand-Sewn Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy for Gastric Cancer

• Norero E
• Muñoz R
• Ceroni M
• Manzor M
• Crovari F
• Gabrielli

• KMID: 2389831
• DOI: http://doi.org/10.5230/jgc.2017.17.e26

Abstract

PURPOSE
Different esophagojejunostomy (EJ) reconstruction methods are used after totally laparoscopic total gastrectomy (TLTG), and none is considered a standard technique. This report describes a 2-layer hand-sewn EJ technique during TLTG; we also evaluated postoperative morbidity associated with this technique.
MATERIALS AND METHODS
This retrospective cohort study included all consecutive patients who underwent TLTG for gastric cancer (GC) from 2012 to 2016 at 2 affiliated teaching hospitals. All participating surgeons performed standardized intracorporeal 2-layer hand-sewn EJ.
RESULTS
We included 51 patients who underwent TLTG for GC and standardized EJ anastomosis. Twenty-seven (53%) were male, and the median age was 60 (36-87) years. The average operative time was 337±71 minutes and intraoperative bleeding was 160±107 mL. There were no open conversions related to EJ. Postoperative morbidity was observed in 9 (17.0%) patients. There was no postoperative mortality. EJ leakage was observed in 2 patients (3.8%) and 1 patient (1.9%) developed EJ stenosis. Patients with leakage were managed non-operatively and the patient with stenosis required endoscopic dilation. The median length of hospital stay was 8 (6-29) days.
CONCLUSIONS
Two-layer hand-sewn EJ during TLTG for GC is a feasible and safe technique. This method avoids a laparotomy for reconstruction and the disadvantages associated with laparoscopic introduction of mechanical staplers for EJ, and provides an alternative for alimentary tract reconstruction after TLTG.

Keyword

Gastrectomy; Stomach neoplasms; Laparoscopy; Esophagojejunostomy

MeSH Terms

Cohort Studies
Constriction, Pathologic
Gastrectomy*
Hemorrhage
Hospitals, Teaching
Humans
Laparoscopy
Laparotomy
Length of Stay
Male
Methods
Mortality
Operative Time
Retrospective Studies
Stomach Neoplasms*
Surgeons

Figure

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  Fig. 1 Trocar position in laparoscopic total gastrectomy.

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  Fig. 2 Two-layer hand-sewn EJ. First posterior layer: a 34-Fr bougie is placed inside the esophagus (A). Suturing the jejunum to the distal end of the esophagus under the complete staple line (B-D). EJ = esophagojejunostomy.

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  Fig. 3 Two-layer hand-sewn EJ. The second posterior layer and the first anterior layer: the anterior esophageal wall is opened immediately above the stapler line and an enterotomy is also created in the jejunum (A). A second posterior layer (B-D) and the first anterior layer are formed (E, F). EJ = esophagojejunostomy.

• 

  Fig. 4 Two-layer hand-sewn EJ. A second anterior layer is formed (A, B) and the anastomosis is completed (C, D). EJ = esophagojejunostomy.

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