Disturbed passage of jejunal limb near esophageal hiatus after overlapped esophagojejunostomy following laparoscopic total gastrectomy

Table 1 Characteristics of the five patients at the first laparoscopic total gastrectomy

Case	1	2	3	4	5
Sex	M	M	M	M	F
Age	69	67	80	74	65
Original disease
Location	Upper	Remnant stomach	Upper	EGJ	Upper
Histological type	Well	Well	Moderately	Well	Poorly
Clinical Stage1	I	I	I	I	I
Pathological Stage1	IA	IA	IIB	IA	IB
Neoadjuvant chemotherapy	-	-	-	-	-
Adjuvant chemotherapy	-	-	+	-	-
Type of gastrectomy	Total	Total (Complete)	Total	Total	Total
Approach	Laparoscopic	Laparoscopic	Laparoscopic	Laparoscopic	Robotic
Operation time (min)	336	475	339	438	368
Blood loss (mL)	130	76	93	35	34
Splenectomy	-	-	-	-	-
Lymph node dissection	D2	D2	D2	D2	D2
Length of excised esophagus (cm)	1.5	1.5	1.5	3.5	2.0
Direction of esophageal transection	Horizontal	Vertical	Horizontal	Horizontal	Horizontal
Site of esophagostomy	Right	Posterior	Right	Right	Right
Enlarged hiatus	Large	Large	Small	Large	Small
Direction	Ventral	Ventral	Ventral	Ventral	Ventral
Closure of enlarged hiatus	-	-	-	-	-
Route of jejunum	Antecolic	Retrocolic	Antecolic	Retrocolic	Antecolic
Insertion of stapler	Left	Left	Left	Left	Left
Fixation of esophagus	-	-	-	-	-
Fixation of jejunum	-	-	-	+	-
Anastomosis site (common channel level)	at hiatus	above hiatus	below hiatus	above hiatus	below hiatus
Drainage	+	+	+	+	+
Resume of oral intake	3	1	3	4	3
Length of hospital stay	11	49	12	17	19
Postoperative complications	-	-	-	-	-

¹TNM classification, 8th edition.

EGJ:Esophagogastric junction.

Table 2 Summary of clinical findings and procedures in the five patients at the reoperation

Case	1	2	3	4	5
Age	69	67	80	76	66
Interval from the 1st operation (mo)	7	9	8	5	21
Preoperative endoscopy
Anastomotic stricture	-	-	-	-	-
Recurrence	-	-	-	-	-
Efferent scope passage	+	+	+	+	+
Bending or tortuous	+	+	+	+	+
Preoperative UGI series
Esophagus dilatation	+	+	+	+	+
Length of jejunal stricture	1.5 cm	0.8 cm	occluded	1.0 cm	1.0 cm
Bending or tortuous	+	+	+	+	+
Preoperative CT
Recurrence	-	-	-	-	-
Pneumonia	+	-	-	+	-
Approach	Laparoscopic	Laparoscopic	Laparoscopic	Laparoscopic	Laparoscopic
Operation time (min)	66	255	118	203	113
Blood loss (mL)	3	223	45	36	10
Number of ports	4	5	5	5	5
Adhesiolysis	+	++	+	+	+
Intraoperative endoscopy	+	+	+	-1	+
Fixation of jejunum	-	+	+	+	+
Left crus cutting	+	+	+	+	+
Resume of oral intake (POD)	1	3	2	2	1
Length of hospital stay (d)	5	7	22	9	6
Postoperative complications	-	-	-	-	-

¹Air insufflation through the nasogastric tube.

UGI: Upper gastrointestinal; CT: Computed tomography; POD: Postoperative day.

Table 3 Changes in body weight of the five patients

Case	1	2	3	4	5	mean
Height (cm)	169.4	164.0	171.5	154.7	145.2	161.0
BW before the first LTG (kg)	66.3	71.3	65.1	57.5	54.8	63.0
BWLR at the discharge of the first LTG (%)	-8.0%	-7.0%	-4.6%	-4.2%	-6.9%	-6.1%
BWLR before the reoperation (%)	-25.3%	-25.5%	-13.8%	-33.0%	-32.3%	-26.0%
BWLR at the discharge of the reoperation (%)	-24.0%	-23.6%	-13.2%	-28.9%	-32.5%	-24.4%
Maximal BWLR from the reoperation (%)	-17.0%	-23.6%	-5.7%	-21.7%	-21.5%	-17.9%

LTG: Laparoscopic total gastrectomy; BW: Body weight; BWLR: Body weight loss rate compared to BW before laparoscopic total gastrectomy.