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Linear-Stapled Side-to-Side Esophagojejunostomy with Hand-Sewn Closure of the Common Enterotomy After Prophylactic and Therapeutic Total Gastrectomy

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Journal of Gastrointestinal Surgery Aims and scope

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.

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Acknowledgments

The authors thank Wenjing Wu of the Department of Communications at Memorial Sloan Kettering Cancer Center for creating the line illustrations.

Author Contribution

Study conception and design: K.K.C. and S.S.Y.

Acquisition of data: K.K.C., M.S.P., and S.S.Y.

Analysis and interpretation of data: K.K.C., M.S.P., and S.S.Y.

Drafting of the manuscript: K.K.C., M.S.P., and S.S.Y.

Critical revision: K.K.C., M.S.P., and S.S.Y.

Final approval of the version to be published: K.K.C., M.S.P., and S.S.Y.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Kevin K. Chang & Sam S. Yoon

  2. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    Madhukar S. Patel

  3. Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H1209, New York, NY, 10065, USA

    Sam S. Yoon

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  1. Kevin K. Chang
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This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

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Chang, K.K., Patel, M.S. & Yoon, S.S. Linear-Stapled Side-to-Side Esophagojejunostomy with Hand-Sewn Closure of the Common Enterotomy After Prophylactic and Therapeutic Total Gastrectomy. J Gastrointest Surg 21, 712–722 (2017). https://doi.org/10.1007/s11605-016-3326-5

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