title: Surgical outcomes of intracorporeal circular-stapled esophagojejunostomy using modified over-and-over suture technique in laparoscopic total gastrectomy.
abstract: BACKGROUND
  Esophagojejunostomy in laparoscopic total gastrectomy (LTG) is a technically demanding procedure. Although several methods have been reported to date, none is considered consistently reliable. We developed a simple method for intracorporeal circular-stapled esophagojejunostomy using a modified over-and-over suture technique. The surgical outcomes of our technique were evaluated in comparison with those of open total gastrectomy (OTG).
  
  
  METHODS
  From April 2012 to August 2014, reconstruction using this method in LTG was performed for 21 consecutive patients with gastric cancer (LTG group). Their surgical outcomes were compared with those of 27 patients with gastric cancer who underwent OTG without splenectomy (OTG group) between January 2011 and April 2014.
  
  
  RESULTS
  Estimated blood loss was significantly lower, and the postoperative hospital stay was significantly shorter in the LTG group than in the OTG group. The operating time and the number of harvested lymph nodes were similar between the two groups. The incidence of overall complications did not differ significantly between the two groups. Anastomotic leakage developed in one of the 21 patients in the LTG group and in two of the 27 patients in the OTG group. Anastomotic stenosis was observed in one patient in the LTG group.
  
  
  CONCLUSIONS
  We consider this method as simple and feasible for most laparoscopic surgeons with basic laparoscopic suturing skills. This method might help LTG to become an accepted standard surgical option for treatment of patients with gastric cancer.
authors: Department of Surgery, National Hospital Organization Kobe Medical Center, 3-1-1 Nishi-Ochiai, Suma-ku, Kobe, 654-0155, Japan. takerumatsuda@nifty.com.
authors: Takeru
authors: T
authors: Matsuda
authors: Department of Surgery, National Hospital Organization Kobe Medical Center, 3-1-1 Nishi-Ochiai, Suma-ku, Kobe, 654-0155, Japan.
authors: Takeshi
authors: T
authors: Iwasaki
authors: Department of Surgery, National Hospital Organization Kobe Medical Center, 3-1-1 Nishi-Ochiai, Suma-ku, Kobe, 654-0155, Japan.
authors: Masaaki
authors: M
authors: Mitsutsuji
authors: Department of Surgery, National Hospital Organization Kobe Medical Center, 3-1-1 Nishi-Ochiai, Suma-ku, Kobe, 654-0155, Japan.
authors: Kenro
authors: K
authors: Hirata
authors: Department of Surgery, National Hospital Organization Kobe Medical Center, 3-1-1 Nishi-Ochiai, Suma-ku, Kobe, 654-0155, Japan.
authors: Yoko
authors: Y
authors: Maekawa
authors: Department of Surgery, National Hospital Organization Kobe Medical Center, 3-1-1 Nishi-Ochiai, Suma-ku, Kobe, 654-0155, Japan.
authors: Daisuke
authors: D
authors: Tsugawa
authors: Department of Surgery, National Hospital Organization Kobe Medical Center, 3-1-1 Nishi-Ochiai, Suma-ku, Kobe, 654-0155, Japan.
authors: Yutaka
authors: Y
authors: Sugita
authors: Department of Surgery, National Hospital Organization Kobe Medical Center, 3-1-1 Nishi-Ochiai, Suma-ku, Kobe, 654-0155, Japan.
authors: Etsuji
authors: E
authors: Shimada
authors: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Yoshihiro
authors: Y
authors: Kakeji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007422:Intestines / Q000601:surgery; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Esophagojejunostomy; Gastric cancer; Laparoscopy
references: Surg Endosc. 2010 Nov;24(11):2908-12
references: 20383532
references: Am J Surg. 2007 Dec;194(6):839-44; discussion 844
references: 18005781
references: Surg Endosc. 2009 Nov;23(11):2624-30
references: 19343421
references: J Am Coll Surg. 2010 Nov;211(5):677-86
references: 20869270
references: Br J Surg. 2007 Feb;94(2):204-7
references: 17058319
references: Surg Endosc. 2013 Oct;27(10):3683-9
references: 23572225
references: Am J Surg. 2009 Jan;197(1):e13-7
references: 19101245
references: Gastric Cancer. 2007;10(3):181-6
references: 17922097
references: Surg Endosc. 2014 Apr;28(4):1250-5
references: 24232135
references: Surg Laparosc Endosc. 1994 Apr;4(2):146-8
references: 8180768
references: Ann Surg. 2010 Mar;251(3):417-20
references: 20160637
references: J Am Coll Surg. 2010 Dec;211(6):e25-9
references: 21036074
references: J Am Coll Surg. 2002 Aug;195(2):284-7
references: 12168979
references: Surg Endosc. 2005 Feb;19(2):168-73
references: 15580441
references: World J Surg. 2004 Sep;28(9):921-5
references: 15593468
references: Gastric Cancer. 2008;11(4):233-7
references: 19132486
references: Surg Today. 2005;35(10):896-9
references: 16175476