title: Creation of a Jejunal Pouch During Laparoscopic Total Gastrectomy and Roux-en-Y Esophagojejunostomy.
abstract: BACKGROUND
  The creation of Hunt-Lawrence jejunal pouches after total gastrectomy is associated with a better quality of life compared with the standard Roux-en-Y esophagojejunostomy. To the authors' knowledge, this is the first video to show the technical aspects of creating a jejunal pouch during a laparoscopic total gastrectomy.
  
  
  METHODS
  A 35-year-old woman was seen for surgical evaluation of a newly diagnosed CDH1 gene mutation. The authors recommended a laparoscopic total gastrectomy with Hunt-Lawrence pouch reconstruction. The jejunal pouch was created using an extracorporeal approach after removal of the stomach. A laparoscopic gel port was then placed over the extraction site to maintain pneumoperitoneum to facilitate a laparoscopic esophagojejunal pouch anastomosis using a circular stapler.
  
  
  RESULTS
  The patient was discharged home on postoperative day 4. Her pathology showed no gastric cancer, and all 31 lymph nodes harvested were free of malignancy. At 1 year postoperatively, she had lost 25 lb from her presurgerical weight and was maintaining a healthy body mass index of 24 kg/m2.
  
  
  CONCLUSIONS
  Hunt-Lawerence jejunal pouches have been shown to improve quality of life compared with esophagojejunostomy without pouch formation after total gastrectomy. This video shows a novel technique for jejunal pouch creation during laparoscopic total gastrectomy using a laparoscopic gel port after gastric extraction to facilitate a laparoscopic esophagojejunal pouch anastomosis.
authors: Department of Surgery, University of Chicago, Chicago, USA. marcward314@gmail.com.
authors: Marc A
authors: MA
authors: Ward
authors: Department of Surgery, University of Chicago, Chicago, USA.|Department of Surgery, NorthShore University HealthSystem, Evanston, USA.
authors: Michael B
authors: MB
authors: Ujiki
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome