J Gastric Cancer.  2011 Dec;11(4):206-211.

Totally Laparoscopic Total Gastrectomy Using Intracorporeally Hand-Sewn Esophagojejunostomy

• So KO
• Park JM

Abstract

PURPOSE
Laparoscopic total gastrectomy (LTG) for gastric cancer is still uncommon because of technical difficulties, especially in esophagojejunostomy (EJ). There are many reports for various laparoscopic procedures of EJ using linear or circular staplers. On the other hands, there has been no report for hand-sewn anastomosis. We report successfully performed intracorporeally hand-sewn EJ after LTG.
MATERIALS AND METHODS
The clinicopathologic data and short-term surgical outcomes of 6 patients who underwent totally laparoscopic total gastrectomy for upper gastric cancer from December 2010 and July 2011 were retrospectively reviewed.
RESULTS
The mean age was 66.5 years and mean body mass index (kg/m2) was 24.6. All patients had medical comorbidities. The mean patient ASA score was 2.17. Among the 6 patients, previous abdominal operation was performed for 2 patients and combined operation was performed for 3 patients. The mean blood loss, operation time, and EJ anastomosis time was 130 ml, 379.7 minutes, and 81.5 minutes, respectively. The mean time to first flatus, first oral intake, and postoperative hospital stay was 3.0, 3.0, and 12.5 days, respectively. There was no 30-day mortality case. Postoperative aspiration pneumonia and multiple periventricular lacunar infarctions developed in 1 patient. There were no anastomosis-related complications and other major surgical complications.
CONCLUSIONS
When the intracorporeal anastomotic technique becomes popular in LTG the intracorporeally hand-sewn EJ may be accepted as one method among the various laparoscopic procedures of EJ.

Keyword

Stomach neoplasms; Laparoscopy; Gastrectomy; Reconstructive surgical procedures

MeSH Terms

Body Mass Index
Comorbidity
Flatulence
Gastrectomy
Hand
Humans
Laparoscopy
Length of Stay
Pneumonia, Aspiration
Reconstructive Surgical Procedures
Retrospective Studies
Stomach Neoplasms
Stroke, Lacunar

Figure

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  Fig. 1 Port placement and minilaparotomy for specimen removal.

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  Fig. 2 Laparoscopic view for intracorporeally hand-sewn esophagojejunostomy.

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  Fig. 3 Postoperative contrast study and esophagogastroduodenoscopy of the first patient. (A) Constrast study was performed on postoperative day 3. It shows no anastomotic leakage. (B) It is endoscopic finding of the esophagojejunostomy site on postoperative 6 months. *It shows no anastomotic stenosis.

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