Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2016; 22(12): 3432-3440
Published online Mar 28, 2016. doi: 10.3748/wjg.v22.i12.3432
Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: A single-center 7-year experience
Ke Chen, Yu Pan, Jia-Qin Cai, Xiao-Wu Xu, Di Wu, Jia-Fei Yan, Rong-Gao Chen, Yang He, Yi-Ping Mou
Ke Chen, Yu Pan, Jia-Qin Cai, Xiao-Wu Xu, Di Wu, Jia-Fei Yan, Rong-Gao Chen, Yang He, Yi-Ping Mou, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Author contributions: Chen K, Pan Y and Cai JQ wrote the manuscript; Mou YP, Xu XW, Chen K, and Yan JF performed the operations; Chen RG, He Y, and Wu D reviewed the medical records and collected data; Mou YP proofread and revised the manuscript; all authors read and approved the final manuscript.
Supported by Natural Science Foundation of Zhejiang Province, No. LY12H16026; and Chinese Medical Technology Foundation of Zhejiang Province, China, No. 2012ZA087.
Institutional review board statement: The study was reviewed and approved by the Zhejiang University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests in this study.
Data sharing statement: No additional data are available.
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: Yi-Ping Mou, MD, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-Invasive Surgery, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. mouyiping2002@163.com
Telephone: +86-571-86006952 Fax: +86-571-86044817
Received: August 7, 2015
Peer-review started: August 10, 2015
First decision: September 9, 2015
Revised: October 14, 2015
Accepted: November 24, 2015
Article in press: November 24, 2015
Published online: March 28, 2016
Processing time: 228 Days and 19.3 Hours
Abstract

AIM: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy (LTG) for gastric cancer.

METHODS: A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records.

RESULTS: The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 mL. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%. However, there were no cases of postoperative death.

CONCLUSION: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness.

Keywords: Gastric cancer; Total gastrectomy; Esophagojejunostomy; Laparoscopy; Hand-sewn

Core tip: Totally laparoscopic distal gastrectomy using intracorporeal anastomosis has gradually increased with advances in laparoscopic surgical instrumentation. However, intracorporeal esophagojejunostomy is still uncommon after totally laparoscopic total gastrectomy due to technical difficulties. Herein, we evaluate various types of intracorporeal esophagojejunostomy using laparoscopic staplers and a hand-sewn technique.