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Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study

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Abstract

Background

Esophagojejunostomy (EJS) represents the most difficult steps during totally laparoscopic total gastrectomy (TLTG). Over the past few years, several techniques have been developed. This study aimed to evaluate the feasibility and surgical outcomes of the laparoscopic intracorporeal side-to-side EJS during TLTG used to treat malignant disease of the stomach.

Methods

This study was conducted from June 2001 to December 2006 at three different institutions. Data were collected from patients’ medical notes, and a database was established that recorded gender, age, American Society of Anesthesiology (ASA) classification, tumor site, operative duration, time required for anastomosis, length of hospital stay, morbidity, mortality, tumor node metastasis (TNM) staging, grading, type of procedure performed, type of lymphadenectomy, conversion rate, reason for conversion, histology type, reoperation rate, reason for reoperation, time required for closure of leak, flatus time, time enteral feeding started, morbidity, and mortality.

Results

In this study, 56 totally laparoscopic gastrectomies (TLGs) (83.6%) and 11 totally laparoscopic degastrogastrectomies (TLDGs) (16.4%) with intracorporeal side-to-side EJS were performed. The average operating time was 249 min (range, 195–349 min). The average time required for both anastomoses was 44 min (17.7% of the average total time). The conversion rate was 10.4%, and the reoperation rate was 13.4%. The mean hospital stay was 12.4 days (range, 8–45 days). The major complications comprised four anastomotic leakage (6%), five postoperative bleeding (7.5%), and two duodenal stump leakage (3%). Most of the patients (91%) were enteral fed on day 6. The mean time for closure of leaks was 12 days (range, 4–18 days). The minor complications comprised two esophagojejunal anastomotic strictures (3%) subsequently treated by endoscopic dilatation. There was one death (1.5%), which occurred within 45 postoperative days.

Conclusions

Laparoscopic intracorporeal side-to-side EJS is a safe and feasible technique. It represents a valid method for performing a reconstruction of the digestive tract in laparoscopic surgery after TLG, especially in presence of a narrow esophagus.

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Disclosures

Umberto Bracale, Ettore Marzano, Piero Nastro, Marco Barone, Diego Cuccurullo, Giorgio Cutini, Francesco Corcione, and Giusto Pignata have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgical Science, PhD School of Surgical Science and Advanced Diagnostic and Therapeutic Technology, University Federico II of Naples, Ospedale San Camillo Via Giovanelli 19, 38100, Trento, Italy

    Umberto Bracale

  2. Department of General and Minimally-Invasive Surgery, Monaldi Hospital, Naples, Italy

    Ettore Marzano, Diego Cuccurullo & Francesco Corcione

  3. Academic Department of Surgery, St. Thomas Hospital, London, UK

    Piero Nastro

  4. Department of General and Minimally-Invasive Surgery, San Polo Hospital, Monfalcone, GO, Italy

    Marco Barone

  5. Department of General and Minimally-Invasive Surgery, Hospital of Jesi, Jesi, Italy

    Giorgio Cutini

  6. Department of General and Minimally-Invasive Surgery, San Camillo Hospital, Trento, Italy

    Giusto Pignata

Authors
  1. Umberto Bracale
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  2. Ettore Marzano
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  3. Piero Nastro
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  4. Marco Barone
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  5. Diego Cuccurullo
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  6. Giorgio Cutini
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  7. Francesco Corcione
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  8. Giusto Pignata
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Corresponding author

Correspondence to Umberto Bracale.

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Bracale, U., Marzano, E., Nastro, P. et al. Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study. Surg Endosc 24, 2475–2479 (2010). https://doi.org/10.1007/s00464-010-0988-z

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  • DOI: https://doi.org/10.1007/s00464-010-0988-z

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