title: Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: inverted T-shaped anastomosis using linear staplers.
abstract: BACKGROUND
  Although laparoscopic distal gastrectomy has been widely accepted in clinical practice, laparoscopic total gastrectomy (LTG) is not yet familiar because of the difficulty in esophagojejunostomy. The purpose of this study was to evaluate perioperative and short-term outcomes of our procedure of intracorporeal gastrojejunostomy using linear staplers after LTG.
  
  
  METHODS
  Of 98 consecutive patients who underwent LTG for gastric cancer in our department between August 2002 and December 2010, 94 patients underwent esophagojejunostomy with a linear stapling device. After October 2007, we modified the esophagojejunostomy; ie, the most recent 57 patients underwent transection of the esophagus in the ventrodorsal direction and insertion of a linear stapler from the anterior wall of the Roux limb to the posterior wall so as to make an inverted T-shaped anastomosis. We evaluated the results in these 57 patients (recent group) and compared them with the results in the earlier 37 patients (early group).
  
  
  RESULTS
  The mean operative time in the recent group was 368 to 94.6 min, and the mean estimated blood loss was 57 to 33 g; both were comparable with those in the early group. Neither open conversion nor intraoperative complications were encountered. Two patients experienced anastomotic leakage in the earlier group, but anastomotic leakage did not occur in the recent group. No mortality was encountered.
  
  
  CONCLUSIONS
  We herein report our procedure of intracorporeal gastrojejunostomy using linear staplers after LTG. Our procedure of esophagojejunostomy using linear staplers is safe and feasible and has acceptable morbidity.
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan. eishi@surg1.med.kyushu-u.ac.jp
authors.forename: Eishi
authors.initials: E
authors.lastname: Nagai
authors.forename: Kenoki
authors.initials: K
authors.lastname: Ohuchida
authors.forename: Kohei
authors.initials: K
authors.lastname: Nakata
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyasaka
authors.forename: Ryo
authors.initials: R
authors.lastname: Maeyama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Toma
authors.forename: Shuji
authors.initials: S
authors.lastname: Shimizu
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D004947:Esophagus / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome