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



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.


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.


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.


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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  1. 1.

    Azagra JS, Goergen M, De Simone P, Ibanez-Aguirre J (1999) The current role of laparoscopic surgery in the treatment of benign gastroduodenal diseases. Hepatogastroenterology 46:1522–1526

    CAS  PubMed  Google Scholar 

  2. 2.

    Abraham NS, Byrne CM, Young JM, Solomon MJ (2007) Metaanalysis of nonrandomized comparative studies of the short-term outcomes of laparoscopic resection for colorectal cancer ANZ J. Surg 77:508–516

    Google Scholar 

  3. 3.

    Dulucq J-L, Wintringer P, Stabilini C, Solinas L, Perissat J, Mahajna A (2005) Laparoscopic and open gastric resections for malignant lesions: a prospective, comparative study. Surg Endosc 19:933–938

    Article  PubMed  Google Scholar 

  4. 4.

    Goh P, Tekant Y, Kum CK, Isaac J, Ngoi SS (1992) Totally intraabdominal laparoscopic Billroth II gastrectomy. Surg Endosc 6:160

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Ferrari GC, Di Lernia S, Costanzi A, Pauna J, de Martini P (2007) Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc 21:21–27

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Asao T, Hosouchi Y, Nakabayashi T, Haga N, Mochiki E, Kuwano H (2001) Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer. Br J Surg 88:128–132

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Chau CH, Siu WT, Li MK (2002) Hand-assisted D2 subtotal gastrectomy for carcinoma of stomach. Surg Laparosc Endosc Percutan Tech 12:268–272

    Article  PubMed  Google Scholar 

  8. 8.

    Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Lirici MM, Napolitano C, Piro F (2004) Videolaparoscopic total and subtotal gastrectomy with extended lynphnode dissection for gastric cancer. Am J Surg 188:728–735

    Article  PubMed  Google Scholar 

  9. 9.

    Orringer MB, Marshall B, Iannettoni MD (2000) Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg 119:277–288

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma. 2nd English edn. Gastric Cancer 1:10–24

    Article  PubMed  Google Scholar 

  11. 11.

    Walther BS, Zilling T, Johnsson F, Staël von Holstein C, Joelsson B (1989) Total gastrectomy and oesophagojejunostomy with linear stapling devices. Br J Surg 76:909–912

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Matsui H, Uyama I, Sugioka A, Fujita J, Komori Y, Ochiai M, Hasumi A (2002) Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy. Am J Surg 184:58–60

    Article  PubMed  Google Scholar 

  13. 13.

    Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, Park SM (2008) Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 22:436–442

    Article  PubMed  Google Scholar 

  14. 14.

    Scurtu R, Groza N, Otel O, Goia A, Funariu G (2005) Quality-of-life patients with esophagojejunal anastomosis after total gastrectomy for cancer. Rom J Gastrenterol 4:367–372

    Google Scholar 

  15. 15.

    Dorsey JS, Esses S, Goldberg M, Stone R (1980) Esophagogastrestomy using the autosuture EEA surgical stapling instrument. Ann Thoracic Surg 30:308–312

    CAS  Article  Google Scholar 

  16. 16.

    Wong J, Cheung H, Lui R, Fan YW, Smith A, Siu KF (1987) Esophagogastrectomy performed with a stapler: the occurrence of leakage and stricture. Surgery 101:408–415

    CAS  PubMed  Google Scholar 

  17. 17.

    Fujimoto S, Takahashi M, Endoh F, Takai M, Kobayashi K, Kiuchi S, Konno C, Obata G, Okui K (1991) Stapled or manual suturing in esophagojejunostomy after total gastrectomy: a comparison of outcome in 379 patients. Am J Surg 16:256–259

    Article  Google Scholar 

  18. 18.

    West PN, Marbarger JP, Martz MN, Roper CL (1981) Esophagogastrostomy with the EEA stappler. Ann Surg 193:76–81

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Nance FC (1979) New Techniques of gastrointestinal anastomoses with the EEA stapler. Ann Surg 189:587–600

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Sannohe Y, Hiratsuka R, Doki K (1981) Single-layer suture by manual or mechanical stapling technique in esophagojejunostomy after total gastrectomy. Am J Surg 142:403–406

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Fleming ID, Cooper JS, Henson DE et al (eds) (1997) AJCC Cancer staging manual, 5th edn. Lippincott-Raven, Philadelphia, PA

    Google Scholar 

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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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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).

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  • Gastric cancer
  • Laparoscopy
  • Side-to-side esophagojejunostomy
  • Total gastrectomy
  • Totally laparoscopic gastrectomy