Two-Layer Hand-Sewn Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy for Gastric Cancer.
- Author:
Enrique NORERO
1
;
Rodrigo MUÑOZ
;
Marco CERONI
;
Manuel MANZOR
;
Fernando CROVARI
;
Mauricio GABRIELLI
Author Information
- Publication Type:Original Article
- Keywords: Gastrectomy; Stomach neoplasms; Laparoscopy; Esophagojejunostomy
- MeSH: Cohort Studies; Constriction, Pathologic; Gastrectomy*; Hemorrhage; Hospitals, Teaching; Humans; Laparoscopy; Laparotomy; Length of Stay; Male; Methods; Mortality; Operative Time; Retrospective Studies; Stomach Neoplasms*; Surgeons
- From:Journal of Gastric Cancer 2017;17(3):267-276
- CountryRepublic of Korea
- Language:English
- 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.
