title: Linear-Stapled Side-to-Side Esophagojejunostomy with Hand-Sewn Closure of the Common Enterotomy After Prophylactic and Therapeutic Total Gastrectomy.
abstract: After total gastrectomy, anastomosis-related complications such as leak or stricture can be highly morbid. Between July 2005 and December 2015, a linear-stapled side-to-side esophagojejunostomy with hand-sewn closure of the common enterotomy (modified Orringer technique) was used for Roux-en-Y reconstruction after prophylactic total gastrectomy in 22 germline CDH1 mutation carriers and after therapeutic total gastrectomy in 18 patients diagnosed with gastric adenocarcinoma. All operations were performed by the same surgeon. No patient in either cohort developed a clinically evident anastomotic leak, one patient (2.5%) developed a contained radiographic leak that healed without intervention, and one patient (2.5%) developed an anastomotic stricture treated by endoscopic dilatation 7 months after operation. These rates were lower than radiographic leak and stricture rates in a comparison group of 32 patients who received a completely hand-sewn esophagojejunostomy (6.3 and 3.1%, respectively). Here, we describe how to perform the linear-stapled esophagojejunostomy anastomosis.
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chang
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Madhukar S
authors.initials: MS
authors.lastname: Patel
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. yoons@mskcc.org.|Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H1209, New York, NY, 10065, USA. yoons@mskcc.org.
authors.forename: Sam S
authors.initials: SS
authors.lastname: Yoon
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology; D015703:Antigens, CD; D015820:Cadherins / Q000235:genetics; D003251:Constriction, Pathologic / Q000209:etiology; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D018095:Germ-Line Mutation; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000235:genetics / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015703:Antigens, CD; C513384:CDH1 protein, human; D015820:Cadherins
keywords: Anastomotic leak; Anastomotic stricture; CDH1 mutation; Esophagojejunostomy; Gastric adenocarcinoma; Hereditary diffuse gastric cancer; Total gastrectomy