Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2015; 21(10): 2973-2981
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.2973
Intracorporeal esophagojejunostomy using the double stapling technique after laparoscopic total gastrectomy: A retrospective case-series study
Jae Hun Kim, Chang In Choi, Dong Il Kim, Dae Hwan Kim, Tae Yong Jeon, Dong Heon Kim, Do Youn Park
Jae Hun Kim, Chang In Choi, Dong Il Kim, Dae Hwan Kim, Tae Yong Jeon, Dong Heon Kim, Department of Surgery, Pusan National University Hospital, Busan 602-739, South Korea
Jae Hun Kim, Chang In Choi, Dae Hwan Kim, Tae Yong Jeon, Dong Heon Kim, Do Youn Park, 2nd BioMedical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea
Do Youn Park, Department of Pathology, Pusan National University Hospital, Busan 602-739, South Korea
Author contributions: Kim JH and Choi CI wrote the paper and contributed equally to this work; Kim DH and Jeon TY performed the surgery; Jeon TY and Kim DH organized the report; Kim DI illustrated the report and analyzed the data; Park DY provided advice for the report.
Supported by Pusan National University; the National R&D Program for Cancer Control at the Ministry for Health, Welfare and Family Affairs, South Korea, No. 0920050.
Ethics approval: This study was reviewed and approved by the Pusan National University Hospital Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors declare no conflicts of interest.
Data sharing: Technical appendix and dataset available from the corresponding author at (111160@pusan.ac.kr).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tae Yong Jeon, MD, PhD, Department of Surgery, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan 602-739, South Korea. 111160@pusan.ac.kr
Telephone: +82-51-2407238 Fax: +82-51-2471365
Received: August 21, 2014
Peer-review started: August 23, 2014
First decision: November 14, 2014
Revised: December 8, 2014
Accepted: February 5, 2015
Article in press: February 5, 2015
Published online: March 14, 2015
Processing time: 207 Days and 8.6 Hours
Abstract

AIM: To introduce a simple and safe anvil insertion technique to esophagus during laparoscopic total gastrectomy (LTG).

METHODS: Between July 2010 and December 2012, 58 consecutive patients with early gastric cancer underwent LTG were enrolled. We performed a simple and safe Roux-en-Y esophagojejunostomy using the double stapling technique to all patients. Then patients’ characteristics, perioperative outcome and histopathologic data were analyzed retrospectively.

RESULTS: The mean age and body mass index were 59.3 ± 9.7 years and 22.7 ± 2.6 kg/m2. The mean operation, reconstruction and anvil insertion times (from gastric incision to linear stapling) were 251.8 ± 57.0, 43.1 ± 2.8 and 4.2 ± 1.9 min, respectively. Intraoperative blood loss was 204.6 ± 156.3 mL and there was no open conversion. The postoperative complications were in 8 cases (delayed gastric emptying in 4 cases, pulmonary complication in 2 cases, pancreatitis in 1 case, anastomotic stricture in 1 case). Anastomotic stricture occurred after discharge and was recovered by endoscopic intervention. The patients were discharged at a mean of 9.6 ± 2.0 d after surgery. Neither leakage nor bleeding from the esophagojejunostomy occurred postoperatively. The mean proximal margin of specimen was 2.7 ± 2.8 cm

CONCLUSION: Roux-en Y esophagojejunostomy using the double stapling technique is simple and rapid, and it may offer a solid, alternative reconstruction method for LTG or proximal gastrectomy.

Keywords: Laparoscopic surgery; Surgical stapling; Roux-en-Y anastomoses; Jejunostomy; Gastrectomy

Core tip: Although laparoscopic total gastrectomy for upper gastric cancer has become popular in Korea, esophagojejunostomy remains a difficult procedure. Recently introduced intracorporeal esophagojejunostomy methods facilitate more convenient anastomosis. We describe the modified double stapling technique (which has been used in colorectal surgery) for esophagojejunostomy after laparoscopic total gastrectomy (LTG). Although it cannot be used for all patients undergoing LTG because of the lack of long-term survival data, this double stapling technique can provide easy and safe anastomosis after LTG. In particular, it may be a considerable option for inexperienced surgeons.