A new option for intracorporeal circular-stapled esophagojejunostomy in laparoscopic total gastrectomy: Roux-en-Y reconstruction with its efferent loop located at the left side of the patient to prevent twisting of the esophagojejunostomy.
OBJECTIVE
Laparoscopic total gastrectomy (LTG) has not gained widespread acceptance because of the difficult reconstruction technique, especially for esophagojejunostomy. Although various modified procedures using a circular stapler for esophagojejunostomy have been reported, an optimal technique has not yet been established. In addition, in intracorporeal techniques, twisting of the esophagojejunostomy, which might be the cause of stenosis, is often encountered because application of the shaft is restricted. To prevent twisting of the esophagoejunostomy, we underwent LTG with Roux-en-Y reconstruction with its efferent loop located at the left side of the patient.


METHODS
From November 2013 to November 2014, a series of 9 patients underwent LTG with Roux-en-Y reconstruction using the transorally inserted anvil (OrVil™, Covidien, Mansfield, MA, USA), whose efferent loop was located at the left side of the patient.


RESULTS
No twisting of the esophagojejunostomy was encountered in all cases. In addition, no stenosis or leakage of the esophagojejunostomy occurred.


CONCLUSIONS
This reconstruction system may be a feasible surgical procedure in LTG.
Takaya
T
Tokuhara
Eiji
E
Nakata
Toshiyuki
T
Tenjo
Isao
I
Kawai
Syunpei
S
Satoi
Keisuke
K
Inoue
Mariko
M
Araki
Hirofumi
H
Ueda
D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D004946:Esophagostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D017792:Surgical Stapling / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome