title: A Step-Wise Approach to Total Laparoscopic Gastrectomy with Jejunal Pouch Reconstruction: How and Why We Do It.
abstract: Laparoscopic gastrectomy (LG) is a safe alternative compared to open gastrectomy for cancer. To increase the uptake of minimally invasive approaches and facilitate their analysis and improvement a stepwise approach is warranted. This study describes our technique and experiences total laparoscopic gastrectomy (TLG) with jejunal pouch reconstruction for gastric cancer. Technical modifications throughout the years were described. In patients with anastomotic leakage, the CT-scan and reoperation report were reviewed to identify the location and cause of the leak. A total of 47 patients who underwent laparoscopic total gastrectomy with extracorporeal jejunal pouch reconstruction and stapled circular esophagojejunostomy from May 2007 to August 2015 were prospectively analyzed. A stepwise approach of 10 steps was designed based on video and case analysis. Median operation time was 301 (148-454) minutes and median blood loss was 300 (30-900) milliliters. Anastomotic leakage occurred in six (12.8 %) patients; additionally, one (2.12 %) jejunal-pouch staple line leak was identified. An important modification in our technique was a purse-string suture around the anvil of the circular stapler to prevent esophageal mucosa to slip away. After this modification, the leakage rate was reduced to 7 % in the last 15 procedures. In conclusion, TLG with jejunal pouch reconstruction is a feasible procedure in a selected group of patients. Our stepwise approach and technique may help surgeons to introduce jejunal pouch reconstruction during laparoscopic gastrectomy in their center.
authors: Department of Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA, Utrecht, The Netherlands.
authors: Hylke J F
authors: HJ
authors: Brenkman
authors: Department of Surgical Oncology, Hospital Pablo Tobón Uribe, Calle 78 B #, 69 - 240, Medellín, Colombia.|Department of Surgical Oncology, University of Toronto, Room 3-130, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
authors: Juan
authors: J
authors: Correa-Cote
authors: Department of Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA, Utrecht, The Netherlands.
authors: Jelle P
authors: JP
authors: Ruurda
authors: Department of Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA, Utrecht, The Netherlands. R.vanHillegersberg@umcutrecht.nl.
authors: Richard
authors: R
authors: van Hillegersberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling
keywords: Gastrectomy; Gastric cancer; Jejunal pouch; Laparoscopy