Langenbeck's Archives of Surgery

, Volume 397, Issue 1, pp 57–62 | Cite as

Esophagogastrostomy using a circular stapler in laparoscopy-assisted proximal gastrectomy with an incision in the left abdomen

  • Daisuke Ichikawa
  • Shuhei Komatsu
  • Kazuma Okamoto
  • Atsushi Shiozaki
  • Hitoshi Fujiwara
  • Eigo Otsuji
Original Article



Recently, the frequency of early gastric cancer in the upper third of the stomach has especially increased. We have improved the esophagogastrostomy procedure to maximize the preservation of physiologic functions.


Eleven patients were reconstructed by esophagogastrostomy with an incision in the left abdomen after limited proximal gastrectomy. We presented here the details of this reconstructive method and demonstrated the results of postoperative evaluations of the lower esophagus and the remaining stomach.


Median surgical duration and blood loss was 330 min and 32 ml for this procedure. The approach using circular stapler from the left side allowed a good laparoscopic visual field to be obtained for the plane of the esophagogastrostomy. The reconstructive procedure was successfully performed without intraoperative complications. There were no anastomosis-related postoperative complications encountered in ten patients, but delayed anastomotic stenosis occurred in one patient. This technique preserved the lower esophageal sphincter as well as peristalsis of the lower stomach and also allowed the greater curvature near the top of the stomach to function as a new fundus. The incidence of reflux esophagitis on endoscopic examination was limited.


This approach for esophagogastrostomy with an incision in the left abdomen could be a simple, easy, and safe reconstructive technique after laparoscopy-assisted proximal gastrectomy with preservation of maximal physiologic function of the remnant stomach.


Laparoscopy Proximal gastrectomy Esophagogastrostomy 



We thank Starmedical Corp. (Tokyo, Japan) for manometric analysis in this study.

Conflicts of interest



  1. 1.
    Salvon-Harman JC, Cady B, Nikulasson S et al (1994) Shifting proportion of gastric adenocarcinomas. Arch Surg 129:381–389PubMedGoogle Scholar
  2. 2.
    Okabayashi T, Gotoda T, Kondo H et al (2000) Early carcinoma of the gastric cardia in Japan: is it different from that in the West? Cancer 89:2555–2559PubMedCrossRefGoogle Scholar
  3. 3.
    Harrison LE, Karpeh MS, Brennan MF (1998) Total gastrectomy is not necessary for proximal gastric cancer. Surgery 123:127–130PubMedCrossRefGoogle Scholar
  4. 4.
    Ichikawa D, Ueshima Y, Shirono K et al (2001) Esophagogastrostomy reconstruction after limited proximal gastrectomy. Hepatogastroenterology 48:1797–1801PubMedGoogle Scholar
  5. 5.
    Shiraishi N, Adachi Y, Kitano S et al (2002) Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer. World J Surg 26:1150–1154PubMedCrossRefGoogle Scholar
  6. 6.
    Katai H, Sano T, Fukagawa T et al (2003) Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg 90:850–853PubMedCrossRefGoogle Scholar
  7. 7.
    Kitano S, Shiraishi N, Uyama I et al (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early gastric cancer in Japan. Ann Surg 245:68–72PubMedCrossRefGoogle Scholar
  8. 8.
    Adachi Y, Suematsu T, Shiraishi N et al (1999) Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg 229:49–54PubMedCrossRefGoogle Scholar
  9. 9.
    Tanimura S, Higashino M, Fukunaga Y et al (2008) Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc 22:1161–1164PubMedCrossRefGoogle Scholar
  10. 10.
    Hiki N, Fukunaga T, Yamaguchi T et al (2007) Laparoscopic esophagogastric circular stapled anastomosis: a modified technique to protect the esophagus. Gastric Cancer 20:181–186CrossRefGoogle Scholar
  11. 11.
    Yamada H, Kojima K, Inokuchi M et al (2008) Preliminary experience using a computer-mediated flexible circular stapler in laparoscopic esophagogastrostomy. Surg Laparosc Endosc Percutan Tech 18:59–63PubMedCrossRefGoogle Scholar
  12. 12.
    Sakuramoto S, Yamashita K, Kikuchi S et al (2009) Clinical experience of laparoscopy-assisted proximal gastrectomy with Toupet-like partial fundoplication in early gastric cancer for preventing reflux esophagitis. J Am Coll Surg 209:344–351PubMedCrossRefGoogle Scholar
  13. 13.
    Aihara Y, Mochiki E, Ohno T et al (2010) Laparoscopy-assisted proximal gastrectomy with gastric tube reconstruction for early gastric cancer. Surg Endosc 24:2343–2348PubMedCrossRefGoogle Scholar
  14. 14.
    Japanese Gastric Cancer Association (2011) Japanese classification for gastric carcinoma. 3rd English edition. Gastric Cancer 14:101–12CrossRefGoogle Scholar
  15. 15.
    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–23CrossRefGoogle Scholar
  16. 16.
    ikuchi S, Nemoto Y, Katada N et al (2007) Results of follow-up endoscopy in patients who underwent proximal gastrectomy with jejunal interposition for gastric cancer. Hepatogastroenterology 54:304–307PubMedGoogle Scholar
  17. 17.
    Uyama I, Sugioka A, Fujita J et al (2000) Completely laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomy. J Am Coll Surg 191:114–119PubMedCrossRefGoogle Scholar
  18. 18.
    Matsui H, Uyama I, Sugioka A et al (2002) Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy. Am J Surg 184:58–60PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Daisuke Ichikawa
    • 1
  • Shuhei Komatsu
    • 1
  • Kazuma Okamoto
    • 1
  • Atsushi Shiozaki
    • 1
  • Hitoshi Fujiwara
    • 1
  • Eigo Otsuji
    • 1
  1. 1.Division of Digestive Surgery, Department of SurgeryKyoto Prefectural University of MedicineKyotoJapan

Personalised recommendations