title: Simplified technique for reconstruction of the digestive tract after total and subtotal gastrectomy for gastric cancer.
abstract: Laparoscopic surgery has been increasingly applied to gastric cancer surgery. Gastrointestinal tract reconstruction totally done by laparoscopy also has been a challenge for those who developed this procedure.
  
  
  
  To describe simplified reconstruction after total or subtotal gastrectomy for gastric cancer by laparoscopy and the results of its application in a series of cases.
  
  
  
  In the last four years, 75 patients were operated with gastric cancer and two with GIST. Thirty-four were women and 43 men. The age ranged from 38 to 77 years with an average of 55 years. In two patients with GIST a total and a subtotal gastrectomy were performed. In the other 75 patients were done 21 total gastrectomies and 54 subtotal. In all cancers, gastrectomy with D2 lymphadenectomy was completed with at least 37 lymph nodes removed. Was used in these operations a modified laparoscopic technique proposed by the authors consisting in a latero lateral esophagojejunal anastomosis with linear stapler in TG as well in STG, and reconstruction of the digestive continuity also in the upper abdomen.
  
  
  
  The intraoperative and immediate postoperative course were uneventful, except for one case of bleeding due to an opening clip, necessitating re-intervention. The operative time was 300 minutes, with no difference between total or subtotal gastrectomy. The number of lymph nodes removed varied from 28 to 69, averaging 37. Postoperative staging showed one case in T4 N2 M0; 13 in T2 N0 MO; 27 in T2 N1 M0; 24 in T3 N1 M0 and 10 in T3 N2 M0. Complication in only one case was observed on the 10th postoperative day with a small anastomotic leakage in esophagojejunal anastomose with spontaneous closure.
  
  
  
  The patient's evolution with no complications, no mortality and just one small anastomotic leakage with no systemic repercussions is a strong indication of the liability and feasibility of this innovative technical method.
authors.affiliation: Department of Gastroenterology, Digestive Surgery and Coloproctology Divisions, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Zilberstein
authors.affiliation: Department of Gastroenterology, Digestive Surgery and Coloproctology Divisions, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Jacob
authors.affiliation: Department of Gastroenterology, Digestive Surgery and Coloproctology Divisions, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Leandro Cardoso
authors.initials: LC
authors.lastname: Barchi
authors.affiliation: Department of Gastroenterology, Digestive Surgery and Coloproctology Divisions, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Osmar Kenji
authors.initials: OK
authors.lastname: Yagi
authors.affiliation: Department of Gastroenterology, Digestive Surgery and Coloproctology Divisions, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Ulysses
authors.initials: U
authors.lastname: Ribeiro
authors.affiliation: Department of Gastroenterology, Digestive Surgery and Coloproctology Divisions, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Brian Guilherme Monteiro Marta
authors.initials: BG
authors.lastname: Coimbra
authors.affiliation: Department of Gastroenterology, Digestive Surgery and Coloproctology Divisions, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D041981:Gastrointestinal Tract / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*