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SHORT-TERM RESULTS OF LAPAROSCOPIC ESOPHAGOJEJUNOSTOMY USING LINEAR STAPLERS AFTER TOTAL GASTRECTOMY FOR GASTRIC CANCER
Toshinaga Nabae*, Toshitatu Ogino, Hideyo Kimura, Shiho Nishimura, Takanori Mei, Yutaka Yamada, Kouki Oyama, Akihiko Uchiyama
Deptment of Surgery, JCHO Kyushu Hospital, Kitakyushu, Fukuoka, Japan
Background:
Laparoscopic distal gastrectomy (LDG) for gastric cancer has been widely accepted. However, laparoscopic total gastrectomy (LTG) is not yet familiar because of the difficulty of esophagojejunostomy. When performing open total gastrectomy, esophagojejunostomy with a circular stapling device is generally accepted. In laparoscopic surgery, the technique using the circular stapler has been developed. Recently, the technique of intracorporeal esophagojejunostomy using linear staplers has been reported. We herein report the short-term outcome of the esophagojejunostomy using linear staplers after total gastrectomy for gastric carcinoma.
Methods:
From January 2006 to August 2016, a total of 908 with gastric cancer underwent laparoscopic gastrectomy in our hospital (LDG : 613 cases, LTG : 278 cases, laparoscopic proximal gastrectomy (LPG) : 17cases). Our procedure of laparoscopic esophagojejunostomy was performed as follows. After the lymph node dissection, the abdominal esophagus was divided using a linear stapler in the horizontal direction. Roux-en-Y reconstruction was performed. The Roux limb was ascended and a linear stapler was inserted into the posterior edge of the esophageal stump and antimesenteric side 5cm from the stump of the Roux limb. After the linear stapler was fired, the entry incision was closed by hand sewing and side-to-side anastomosis of the esophagojejunostomy was completed. Postoperative complications (anastomotic leakage, anastomotic stenosis) and operative results were evaluated.
Results:
Mean operating time of LTG was 410 minutes and mean blood loss was 96.9g. The rate of early complications was 1.8% (anastomotic leakage : 5 cases, anastomotic stenosis : 0 cases). Mean postoperative hospital stay was 16 days. The hospital mortality rate was 0.36%.
Conclusions:
Although our date may be considered preliminary, these findings indicate that the esophagojejunostomy using the linear staplers after total gastrectomy for gastric cancer may be acceptable procedure.
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