Laparoscopic conversion of an omega in a Roux-en-y reconstruction after mini-invasive total gastrectomy for cancer: a technical report.
BACKGROUND
Few cases of laparoscopic total gastrectomy have been published. Reconstruction of the digestive tract was generally accomplished with a Roux-en-y esophagojejunal mechanical anastomosis. Here we report the first 2 cases of laparoscopic conversion of an omega in a Roux-en-y reconstruction due to the occurrence of a severe alkaline esophagitis after mini-invasive total gastrectomy for cancer.


METHODS
Two male patients presented in 2004. One year prior, at another facility, they had undergone laparoscopic total gastrectomy for cancer, with reconstruction of digestive tract by means of an esophagojejeunostomy with a jejunal loop and Braun's side-to-side enteroanastomosis. They complained of daily symptoms of nausea, regurgitation, heartburn, and early postprandial fullness with reduction of appetite and weight loss of almost 15 kg. Instrumental examination diagnosed alkaline esophagitis. Intervention was performed via laparoscopic approach and the digestive reconstruction was reconfigured in a Roux-en-y type with a proximal limb of almost 60 cm.


RESULTS
Operative time was 135 to 180 minutes. No postoperative complications occurred. After 1-year follow-up, symptoms resolution and esophagitis healing have been observed in both patients.


CONCLUSIONS
Laparoscopic gastrectomy is gaining wide acceptance. In our opinion, a standardization of the technique is necessary: we believe Roux-en-y should be considered the preferred reconstruction route ensuring the best protection of the esophagus from alkaline reflux.
Rossetti
Gianluca
G
I Division of General and Gastrointestinal Surgery, Second University of Naples, Via Pansini, 5-80131 Naples, Italy. gianlucarossetti@yahoo.it
del Genio
Gianmattia
G
Maffettone
Vincenzo
V
Napolitano
Vincenzo
V
Brusciano
Luigi
L
Russo
Gianluca
G
Limongelli
Paolo
P
Fiume
Irene
I
Pizza
Francesco
F
del Genio
Alberto
A
D000713:Anastomosis, Roux-en-Y; D004941:Esophagitis / Q000601:surgery*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011677:Punctures; D013274:Stomach Neoplasms / Q000601:surgery*