Noshiro H, Okuyama K, Yoda Y. Disturbed passage of jejunal limb near esophageal hiatus after overlapped esophagojejunostomy following laparoscopic total gastrectomy. World J Gastrointest Surg 2022; 14(11): 1285-1296 [PMID: 36504516 DOI: 10.4240/wjgs.v14.i11.1285]
Corresponding Author of This Article
Hirokazu Noshiro, FACS, MD, PhD, Professor, Surgeon, Department of Surgery, Saga University Faculty of Medicine, Nabeshima 5-1-1, Saga 849-8501, Japan. noshiro@cc.saga-u.ac.jp
Research Domain of This Article
Surgery
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Nov 27, 2022; 14(11): 1285-1296 Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1285
Disturbed passage of jejunal limb near esophageal hiatus after overlapped esophagojejunostomy following laparoscopic total gastrectomy
Hirokazu Noshiro, Keiichiro Okuyama, Yukie Yoda
Hirokazu Noshiro, Yukie Yoda, Department of Surgery, Saga University Faculty of Medicine, Saga 849-8501, Japan
Keiichiro Okuyama, Department of Surgery, Saga University, Saga 849-8501, Japan
Author contributions: Noshiro H contributed to conceptualization, methodology, formal analysis, investigation, writing-original draft, writing-review & editing; Okuyama K contributed to writing-review & editing; Yoda Y contributed to investigation; All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of Saga University Hospital (Approval No. 2020-05-R-02).
Informed consent statement: Informed written consent was obtained from the patient and her family for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hirokazu Noshiro, FACS, MD, PhD, Professor, Surgeon, Department of Surgery, Saga University Faculty of Medicine, Nabeshima 5-1-1, Saga 849-8501, Japan. noshiro@cc.saga-u.ac.jp
Received: July 25, 2022 Peer-review started: July 25, 2022 First decision: September 4, 2022 Revised: September 16, 2022 Accepted: October 31, 2022 Article in press: October 31, 2022 Published online: November 27, 2022 Processing time: 122 Days and 19.9 Hours
Abstract
BACKGROUND
Overlapped esophagojejunostomy (OEJ) is a secure purely laparoscopic reconstruction after laparoscopic total gastrectomy (LTG). However, long-term surgical results have not been documented well.
AIM
In this paper, we report unusual patients who manifested jejunal limb stricture near the esophageal hiatus without anastomotic stenosis during long-term observation after surgery.
METHODS
From April 2009 until May 2020, we retrospectively reviewed 211 patients underwent LTG following by OEJ for gastric carcinoma and took a standard surveillance program. We aimed to characterize a novel complicated disorder observed in these patients to assist treatment and prevention.
RESULTS
Five patients (2.4%) had unusual jejunal limb stricture after LTG and OEJ, occurring at a mean of 10 mo after initial radical LTG. All five patients had disturbed oral intake and marked weight loss, and two had aspiration pneumonia. Various diagnostic modalities and intraoperative findings in each patient revealed an intact anastomosis, bent or tortuous jejunal limb resulting from loose fibrous adhesions on the left crus at the esophageal hiatus and no cancer recurrence. All five patients were successfully treated by reoperation for adhesiolysis, division of the left crus and rearrangement of the jejunal limb.
CONCLUSION
Disturbed passage through the jejunal limb near the hiatus can occur after some types of OEJ following LTG. We speculate that it may result from a short remnant esophagus, excessive mobilization of the jejunal limb that permits bending or tortuosity and adhesions on the left crus at the hiatus. Prevention for this complication is possible during the original LTG procedure.
Core Tip: Overlapped esophagojejunostomy (OEJ) is a secure purely laparoscopic reconstruction after laparoscopic total gastrectomy (LTG). However, disturbed passage through the jejunal limb near the esophageal hiatus can occur. In this paper, mechanisms and prevention for this complication are described. Five patients (2.4%) had disturbed oral intake and marked weight loss, all had unusual jejunal limb stricture after LTG and OEJ. Reoperation for adhesiolysis and division of the left crus and rearrangement of the jejunal limb was required. Prevention for this complication is possible during the original LTG procedure.
