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International Session (Symposium)4 (JSGS・JSGE)
Fri. October 13th   9:40 - 12:00   Room 10: Fukuoka International Congress Center 501
Reconstruction after laparoscopic gastrectomy-Our procedure and clinical results-
K. Kojima1, T. Tanioka1, M. Inokuchi1
1Deapartment of Gastric Surgery, Tokyo Medical and Dental University
BackgroundWe have performed intracorporeal gastrojejunostomy and esophagojejunostomy since 2009. Purely laparoscopic reconstruction doesn't depend on the patient's figure.We have adapted R-Y reconstruction after LDG and LTG and adapted double-tract reconstruction after LPG Regarding the esophagojejunostomy, we use circular stapler for the first choice. If the lesion invades esophagus, we adapted overlap method or oral anvil insertion. Surgical procedure of esophagojejunostomy:The left inferior incision was extended to 4 cm. The anvil head and the PSD were inserted into the abdominal cavity from the extended left inferior incision. The stump of the esophagus was grasped with the PSD, and purse-string suture was made. The PSD was dislodged. The anvil head was inserted into the stump of the esophagus and fixed by ligature thread.The jejunum 25 cm distal to the ligament of Treitz turned out through the left inferior incision. The CS was inserted at this point, and temporarily fixed to the jejunum. The trocar of the CS penetrated the jejunum, as observed by laparoscopy. An antecolic jejunal loop was created, and an esophagojejunostomy was performed using the CS. Finally, we closed the stump of the jejunum by ELS.ResultsFrom November 2009 to December 2016, we performed 61 esophagojejunostomy procedures using CS. The complications observed were anastomotic leakage in 1 case and jejunal stump leakage in 1 case.ConclusionIntracorporeal esophagojejunostomy using CS is a feasible and safe procedure after LTG.
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