title: Technique of Roux-en-Y reconstruction using overlap method after laparoscopic total gastrectomy for gastric cancer: 100 consecutively successful cases.
abstract: We have established a standard procedure for Roux-en-Y (RY) reconstruction in laparoscopic total gastrectomy (LTG) using esophagojejunostomy by the overlap method (OL). We report on our RY reconstruction technique and special approaches, and evaluate the usefulness of our reconstruction method based on the surgical results of 100 patients we have experienced to date.
  
  
  
  We performed LTG in 100 patients with gastric cancer. After total gastrectomy using five ports, the resected stomach was extracted through a small laparotomy. Through that, we performed sacrifice of the jejunum, Y limb anastomosis, creation of the lifted jejunum. As the OL, a side-to-side anastomosis of the lifted jejunum to the esophageal stump was laparoscopically performed using a linear stapler in an isoperistaltic direction, and the entry hole was closed with full-thickness suturing. The lifted jejunum was fixed with suture to the duodenal stump at a location where the esophagojejunostomy site was made linear, and the duodenal stump was buried. The mesenteric gap was laparoscopically closed with suture.
  
  
  
  The median operative time in 100 patients undergoing LTG was 385 min, the median blood loss was 65 mL, and the median time required for the OL was 32 min. The mean hospitalization period was 10 days, and postoperative complications included bleeding requiring reoperation in one patient; other complications such as pancreatic fistula in five patients (5 %) were treated conservatively. No complication associated with anastomosis occurred.
  
  
  
  In RY reconstruction using the OL, there were no complications associated with the anastomosis site in 100 consecutive patients, such as anastomotic leak or stenosis, indicating that it is a very useful and safe reconstruction method.
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan. Kitagami@phoenix-c.or.jp.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Kitagami
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Morimoto
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
authors.forename: Yo
authors.initials: Y
authors.lastname: Kurashima
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nonoyama
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Fujihata
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yasuda
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
authors.forename: Moritsugu
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000453:epidemiology; D002277:Carcinoma / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010185:Pancreatic Fistula / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000601:surgery*; D013537:Sutures
keywords: Esophagojejunostomy; Laparoscopic total gastrectomy; Overlap method; Roux-en-Y reconstruction