title: Esophagogastrostomy using a circular stapler in laparoscopy-assisted proximal gastrectomy with an incision in the left abdomen.
abstract: OBJECTIVE
  Recently, the frequency of early gastric cancer in the upper third of the stomach has especially increased. We have improved the esophagogastrostomy procedure to maximize the preservation of physiologic functions.
  
  
  METHODS
  Eleven patients were reconstructed by esophagogastrostomy with an incision in the left abdomen after limited proximal gastrectomy. We presented here the details of this reconstructive method and demonstrated the results of postoperative evaluations of the lower esophagus and the remaining stomach.
  
  
  RESULTS
  Median surgical duration and blood loss was 330 min and 32 ml for this procedure. The approach using circular stapler from the left side allowed a good laparoscopic visual field to be obtained for the plane of the esophagogastrostomy. The reconstructive procedure was successfully performed without intraoperative complications. There were no anastomosis-related postoperative complications encountered in ten patients, but delayed anastomotic stenosis occurred in one patient. This technique preserved the lower esophageal sphincter as well as peristalsis of the lower stomach and also allowed the greater curvature near the top of the stomach to function as a new fundus. The incidence of reflux esophagitis on endoscopic examination was limited.
  
  
  CONCLUSIONS
  This approach for esophagogastrostomy with an incision in the left abdomen could be a simple, easy, and safe reconstructive technique after laparoscopy-assisted proximal gastrectomy with preservation of maximal physiologic function of the remnant stomach.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan. ichikawa@koto.kpu-m.ac.jp
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D013270:Stomach / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery*; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000379:methods*