BACKGROUND: Esophagojejunostomy (EJS) represents the most difficult steps during totally laparoscopic total gastrectomy (TLTG). Over the past few years, several techniques have been developed. This study aimed to evaluate the feasibility and surgical outcomes of the laparoscopic intracorporeal side-to-side EJS during TLTG used to treat malignant disease of the stomach. METHODS: This study was conducted from June 2001 to December 2006 at three different institutions. Data were collected from patients' medical notes, and a database was established that recorded gender, age, American Society of Anesthesiology (ASA) classification, tumor site, operative duration, time required for anastomosis, length of hospital stay, morbidity, mortality, tumor node metastasis (TNM) staging, grading, type of procedure performed, type of lymphadenectomy, conversion rate, reason for conversion, histology type, reoperation rate, reason for reoperation, time required for closure of leak, flatus time, time enteral feeding started, morbidity, and mortality. RESULTS: In this study, 56 totally laparoscopic gastrectomies (TLGs) (83.6%) and 11 totally laparoscopic degastrogastrectomies (TLDGs) (16.4%) with intracorporeal side-to-side EJS were performed. The average operating time was 249 min (range, 195-349 min). The average time required for both anastomoses was 44 min (17.7% of the average total time). The conversion rate was 10.4%, and the reoperation rate was 13.4%. The mean hospital stay was 12.4 days (range, 8-45 days). The major complications comprised four anastomotic leakage (6%), five postoperative bleeding (7.5%), and two duodenal stump leakage (3%). Most of the patients (91%) were enteral fed on day 6. The mean time for closure of leaks was 12 days (range, 4-18 days). The minor complications comprised two esophagojejunal anastomotic strictures (3%) subsequently treated by endoscopic dilatation. There was one death (1.5%), which occurred within 45 postoperative days. CONCLUSIONS: Laparoscopic intracorporeal side-to-side EJS is a safe and feasible technique. It represents a valid method for performing a reconstruction of the digestive tract in laparoscopic surgery after TLG, especially in presence of a narrow esophagus.
BACKGROUND: Esophagojejunostomy (EJS) represents the most difficult steps during totally laparoscopic total gastrectomy (TLTG). Over the past few years, several techniques have been developed. This study aimed to evaluate the feasibility and surgical outcomes of the laparoscopic intracorporeal side-to-side EJS during TLTG used to treat malignant disease of the stomach. METHODS: This study was conducted from June 2001 to December 2006 at three different institutions. Data were collected from patients' medical notes, and a database was established that recorded gender, age, American Society of Anesthesiology (ASA) classification, tumor site, operative duration, time required for anastomosis, length of hospital stay, morbidity, mortality, tumor node metastasis (TNM) staging, grading, type of procedure performed, type of lymphadenectomy, conversion rate, reason for conversion, histology type, reoperation rate, reason for reoperation, time required for closure of leak, flatus time, time enteral feeding started, morbidity, and mortality. RESULTS: In this study, 56 totally laparoscopic gastrectomies (TLGs) (83.6%) and 11 totally laparoscopic degastrogastrectomies (TLDGs) (16.4%) with intracorporeal side-to-side EJS were performed. The average operating time was 249 min (range, 195-349 min). The average time required for both anastomoses was 44 min (17.7% of the average total time). The conversion rate was 10.4%, and the reoperation rate was 13.4%. The mean hospital stay was 12.4 days (range, 8-45 days). The major complications comprised four anastomotic leakage (6%), five postoperative bleeding (7.5%), and two duodenal stump leakage (3%). Most of the patients (91%) were enteral fed on day 6. The mean time for closure of leaks was 12 days (range, 4-18 days). The minor complications comprised two esophagojejunal anastomotic strictures (3%) subsequently treated by endoscopic dilatation. There was one death (1.5%), which occurred within 45 postoperative days. CONCLUSIONS: Laparoscopic intracorporeal side-to-side EJS is a safe and feasible technique. It represents a valid method for performing a reconstruction of the digestive tract in laparoscopic surgery after TLG, especially in presence of a narrow esophagus.
Authors: Cristiano G Huscher; Andrea Mingoli; Giovanna Sgarzini; Andrea Sansonetti; Marco M Lirici; Carmine Napolitano; Francesca Piro Journal: Am J Surg Date: 2004-12 Impact factor: 2.565
Authors: Jin-Jo Kim; Kyo Young Song; Hyung Min Chin; Wook Kim; Hae Myung Jeon; Cho Hyun Park; Seung Man Park Journal: Surg Endosc Date: 2008-02 Impact factor: 4.584
Authors: Bang Wool Eom; Young-Woo Kim; Sang Eok Lee; Keun Won Ryu; Jun Ho Lee; Hong Man Yoon; Soo-Jeong Cho; Myeong-Cherl Kook; Soo Jin Kim Journal: Surg Endosc Date: 2012-05-31 Impact factor: 4.584
Authors: Stefano Caruso; Alberto Patriti; Franco Roviello; Lorenzo De Franco; Franco Franceschini; Andrea Coratti; Graziano Ceccarelli Journal: World J Gastroenterol Date: 2016-07-07 Impact factor: 5.742