title: Laparoscopic minimally invasive total gastrectomy with linear stapled oesophagojejunostomy--experience from the first thirty procedures.
abstract: BACKGROUND
  There are only few reports on total gastrectomy by a laparoscopic surgical approach. One explanation is the fear of complications due to anastomotic dehiscence in oesophagojejunal anastomosis known to carry high morbidity and mortality. The introduction of staplers have contributed to making anastomosis safer and easier to perform and has facilitated more advanced laparoscopic surgery. In open surgery, most surgeons use a circular stapler for oesophagojejunal anastomosis or a hand sutured technique. Both techniques are difficult to use in laparoscopic surgery, especially if the oesophagus is narrow. To facilitate the creation of oesophagojejunal anastomoses, we have adopted a technique with a linear stapled anastomosis. Our method is based on a stapling technique where the oesophagus is divided above the gastric cardia followed by a oesophagojejunostomy performed with Covidien's new Endo GIA-60™ Ultra Universal stapler. The residual opening is closed with a 3-0 re-absorbable suture.
  
  
  METHODS
  From June 2009 to May 2012, 14 men and 16 women (median age=66 years, range=39-84 years) underwent laparoscopic total gastrectomy due to gastric cancer.
  
  
  RESULTS
  One patient died during hospital stay; corresponding to a postoperative mortality of 3,3%. Leakage in the oesophagojejunal anastomosis occurred in three patients (10%). Two of the patients with leakage in the oesophagojejunal anastomosis had an additional duodenal bulb leakage, which might have caused anastomotic dehiscence. The patients had a median postoperative hospital stay of six days (range=3-156 days). Six patients had a re-operation due to complications, including one endoscopic stent application in the anastomosis.
  
  
  CONCLUSIONS
  Even though a leakage rate of 10% can be considered high, this study describes a simple method for performing oesophagojejunostomy after gastrectomy by a laparoscopic approach independently of the width of the oesophagus. This study also shows that laparoscopic gastrectomy can be performed in more advanced stages of gastric cancer.
authors.affiliation: Department of Surgical Gastroenterology L, Aarhus University Hospital, Nørrebrogade 44, DK 8000 Åarhus C, Denmark. torbpete@rm.dk
authors.forename: Torben Ingemann
authors.initials: TI
authors.lastname: Petersen
authors.forename: Einar
authors.initials: E
authors.lastname: Pahle
authors.forename: Thorbjørn
authors.initials: T
authors.lastname: Sommer
authors.forename: Thomas
authors.initials: T
authors.lastname: Zilling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009362:Neoplasm Metastasis; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery; D017792:Surgical Stapling
keywords: Total gastrectomy; gastric cancer; minimally-invasive surgical technique; oesophagojejunal anastomosis; stapling devices