Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
Similar content being viewed by others
References
Salvon-Harman JC, Cady B, Nikulasson S et al (1994) Shifting proportion of gastric adenocarcinomas. Arch Surg 129:381–389
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 89:2555–2559
Harrison LE, Karpeh MS, Brennan MF (1998) Total gastrectomy is not necessary for proximal gastric cancer. Surgery 123:127–130
Ichikawa D, Ueshima Y, Shirono K et al (2001) Esophagogastrostomy reconstruction after limited proximal gastrectomy. Hepatogastroenterology 48:1797–1801
Shiraishi N, Adachi Y, Kitano S et al (2002) Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer. World J Surg 26:1150–1154
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 90:850–853
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 245:68–72
Adachi Y, Suematsu T, Shiraishi N et al (1999) Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg 229:49–54
Tanimura S, Higashino M, Fukunaga Y et al (2008) Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc 22:1161–1164
Hiki N, Fukunaga T, Yamaguchi T et al (2007) Laparoscopic esophagogastric circular stapled anastomosis: a modified technique to protect the esophagus. Gastric Cancer 20:181–186
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 18:59–63
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 209:344–351
Aihara Y, Mochiki E, Ohno T et al (2010) Laparoscopy-assisted proximal gastrectomy with gastric tube reconstruction for early gastric cancer. Surg Endosc 24:2343–2348
Japanese Gastric Cancer Association (2011) Japanese classification for gastric carcinoma. 3rd English edition. Gastric Cancer 14:101–12
Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–23
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 54:304–307
Uyama I, Sugioka A, Fujita J et al (2000) Completely laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomy. J Am Coll Surg 191:114–119
Matsui H, Uyama I, Sugioka A et al (2002) Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy. Am J Surg 184:58–60
Acknowledgment
We thank Starmedical Corp. (Tokyo, Japan) for manometric analysis in this study.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ichikawa, D., Komatsu, S., Okamoto, K. et al. Esophagogastrostomy using a circular stapler in laparoscopy-assisted proximal gastrectomy with an incision in the left abdomen. Langenbecks Arch Surg 397, 57–62 (2012). https://doi.org/10.1007/s00423-011-0840-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-011-0840-5