Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1285
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
Overlapped esophagojejunostomy (OEJ) is a secure purely laparoscopic reconstruction after laparoscopic total gastrectomy (LTG). However, long-term surgical results have not been documented well.
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.
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.
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 dis
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.