BACKGROUND: Even for expert surgeons, esophagojejunostomy after laparoscopic total gastrectomy (LTG) is not always easy to perform. Herein, we compare various types of esophagojejunostomy in terms of the technical aspects and postoperative outcomes. METHODS: A total of 48 patients underwent LTG for gastric cancer by the same surgeon. Four types of intracorporeal esophagojejunostomies have been applied after LTG: type A, a conventional anvil head method; type B, an OrVil™ system method; type C, a hemi-double stapling technique with anvil head; and type D, side-to-side esophagojejunostomy with linear stapler. We describe and review these types of esophagojejunostomy using a step-by-step approach. RESULTS: The mean reconstruction times were longer for types A and B than for types C and D (p < 0.05). In terms of complications, there were five cases (10.4%) of anastomosis leakage, which was more common in types A and B: two cases in each of type A and B and one case in type C. Moreover, anastomosis stricture requiring intervention was more common in types A and B (p < 0.05). CONCLUSIONS: To date, there are no reliable reconstruction methods after LTG. Therefore, special care is needed to prevent postoperative complication regardless of methods; also, technical innovations to support development of the safest methods of esophagojejunostomy are warranted.
BACKGROUND: Even for expert surgeons, esophagojejunostomy after laparoscopic total gastrectomy (LTG) is not always easy to perform. Herein, we compare various types of esophagojejunostomy in terms of the technical aspects and postoperative outcomes. METHODS: A total of 48 patients underwent LTG for gastric cancer by the same surgeon. Four types of intracorporeal esophagojejunostomies have been applied after LTG: type A, a conventional anvil head method; type B, an OrVil™ system method; type C, a hemi-double stapling technique with anvil head; and type D, side-to-side esophagojejunostomy with linear stapler. We describe and review these types of esophagojejunostomy using a step-by-step approach. RESULTS: The mean reconstruction times were longer for types A and B than for types C and D (p < 0.05). In terms of complications, there were five cases (10.4%) of anastomosis leakage, which was more common in types A and B: two cases in each of type A and B and one case in type C. Moreover, anastomosis stricture requiring intervention was more common in types A and B (p < 0.05). CONCLUSIONS: To date, there are no reliable reconstruction methods after LTG. Therefore, special care is needed to prevent postoperative complication regardless of methods; also, technical innovations to support development of the safest methods of esophagojejunostomy are warranted.
Authors: Jun Ho Lee; Keun Won Ryu; Young Woo Doh; Ja Seong Bae; Young Woo Kim; Jae-Moon Bae Journal: J Surg Oncol Date: 2007-01-01 Impact factor: 3.454
Authors: Sang Eok Lee; Keun Won Ryu; Byung Ho Nam; Jun Ho Lee; Young-Woo Kim; Jun Sik Yu; Soo Jeong Cho; Jong Yeul Lee; Chan Gyoo Kim; Il Ju Choi; Myeong Cherl Kook; Sook Ryun Park; Min Ju Kim; Jong Seok Lee Journal: J Surg Oncol Date: 2009-10-01 Impact factor: 3.454
Authors: Abdelmonim E A Salih; Gary A Bass; Yvonne D'Cruz; Robert P Brennan; Sebastian Smolarek; Mayilone Arumugasamy; Thomas N Walsh Journal: Surg Endosc Date: 2014-08-27 Impact factor: 4.584