title: Esophagojejunostomy through minilaparotomy after laparoscopic total gastrectomy.
abstract: Although laparoscopic distal gastrectomy (LDG) has been accepted as a surgical option for the treatment of early gastric cancer, laparoscopic total gastrectomy (LTG) has been adopted less often, because a more difficult surgical technique is required for reconstruction. To reduce the technical difficulties, we made some modifications to the functional end-to-end anastomosis technique and performed esophagojejunal anastomosis through a minilaparotomy. First, for easier handling of the esophagus, the first application of the linear stapler to create the esophagojejunal anastomosis was performed before transection of the esophagus. Second, the jejunal limb was anastomosed to the left side of the esophagus, which, compared with the right side, made available more free space, sufficient to operate the stapling device. Third, to close the entry hole and complete the gastrectomy concurrently, a linear stapler was applied through the left lower trocar. With this technique, the closure of the access opening was performed easily and was monitored directly through the minilaparotomy. We successfully performed LTG with Roux-en-Y reconstruction using our modified procedure in seven patients without any anastomotic complications. We believe our procedure is a secure and reliable method for reconstruction after LTG and will facilitate adoption of LTG as a surgical option for patients with early upper gastric cancers.
authors.affiliation: Department of Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okabe
authors.forename: Seiji
authors.initials: S
authors.lastname: Satoh
authors.forename: Harutaka
authors.initials: H
authors.lastname: Inoue
authors.forename: Masato
authors.initials: M
authors.lastname: Kondo
authors.forename: Jun-ichiro
authors.initials: J
authors.lastname: Kawamura
authors.forename: Akinari
authors.initials: A
authors.lastname: Nomura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagayama
authors.forename: Suguru
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Itami
authors.forename: Go
authors.initials: G
authors.lastname: Watanabe
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D004946:Esophagostomy / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods