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Comprehensive linear stapling anastomosis for totally laparoscopic total gastrectomy and proximal gastrectomy
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N. Inaki1,
T. Tsuji1 |
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1Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital |
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| BACKGROUND: Since 2008, we have performed totally laparoscopic total gastrectomy (TLTG) followed by Roux-en Y reconstruction and totally laparoscopic proximal gastrectomy (TLPG) followed by double-tract reconstruction for upper gastric cancer. Our comprehensive linear stapling esophagojejunostomy is demonstrated and its clinical results are evaluated.PATIENTS AND METHODS: Patients who underwent TLTG or TLPG from January 2008 till March 2016 were included. Side to side anastomosis using linear stapler: Overlap technique is carried out for esophago-jejunostomy. Jejuno-gastrostomy in TLPG has been recently done in the new way of NI-shaped method using linear stapler.SURGICAL TECHNIQUE: All reconstruction procedure is performed in totally laparoscopic way using linear stapler. Overlap is chosen for esophago-jejunostomy after TLTG and TLPG. The entry hole of the stapler is closed by intracorporeal suturing using barbed suture. In TLPG, jejuno-gastrostomy is also carried out in totally laparoscopic way using linear stapler. The jejunum is unfolded 15cm apart from the esophago-jejunostomy just on the remnant stomach. Then stapling is done from anal-side to oral side on the remnant stomach and from unfolded point to distal side on the jejunum.RESULTS: All cases were laparoscopically completed without any intraoperative complications. CONCLUSIONS: Our linear stapling esophagojejunostomy for TLTG and TLPG is considered to be comprehensive. Our newly NI-shaped anastomosis for jejuno-gastrostomy in TLPG is functional. These technique might become one of the standard methods for patients with upper gastric cancer. |
Index Term 1: totally laparoscopic total gastrectomy
Index Term 2: totally laparoscopic proximal gastrectomy |
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