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Intra-corporeal hand-sewn esophagojejunostomy is a safe and feasible procedure for totally laparoscopic total gastrectomy: short-term outcomes in 100 consecutive patients

Surgical Endoscopy volume 32, pages 2689–2695 (2018)Cite this article

Abstract

Background

An optimal method for intracorporeal esophagojejunostomy has not yet been standardized. This study sought to introduce intracorporeal hand-sewn end-to-side esophagojejunostomy after totally laparoscopic total gastrectomy.

Methods

The author conducted a consecutive series of 100 intracorporeal hand-sewn esophagojejunostomies after totally laparoscopic total gastrectomy for upper third gastric cancer from September 2012 to December 2016.

Results

All patients were successfully operated on without conversion to open- or laparoscope-assisted surgery. The mean reconstruction time was 45 min, and the time until first flatus was 4 days. The time to start a soft diet was 7 days. The length of postoperative hospital stay was 8 days. The overall postoperative morbidity was 8%, including one anastomotic leak, and the mortality was zero. The median follow-up duration was 13 months; no anastomotic strictures were encountered.

Conclusions

Intracorporeal hand-sewn end-to-side esophagojejunostomy after totally laparoscopic total gastrectomy is a safe and feasible procedure. This method can identify negative margins with intraoperative frozen sections before reconstruction and could be a good option for performing intracorporeal esophagojejunostomy with an advanced endoscopic suture technique.

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References

  1. Haverkamp L, Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, van Hillegersberg R (2013) Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis. Surg Endosc 27:1509–1520

    Article  PubMed  Google Scholar 

  2. Straatman J, van der Wielen N, Cuesta MA, de Lange-de Klerk ESM, Jansma EP, van der Peet DL (2016) Minimally invasive versus open total gastrectomy for gastric cancer: a systematic review and meta-analysis of short-term outcomes and completeness of resection: Surgical techniques in gastric cancer. World J Surg 40:148–157

    Article  PubMed  Google Scholar 

  3. Inokuchi M, Otsuki S, Fujimori Y, Sato Y, Nakagawa M, Kojima K (2015) Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy. World J Gastroenterol 21:9656–9665

    Article  PubMed  PubMed Central  Google Scholar 

  4. Okabe H, Obama K, Tanaka E, Nomura A, Kawamura J-i, Nagayama S, Itami A, Watanabe G, Kanaya S, Sakai Y (2009) Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc 23:2167–2171

    Article  PubMed  Google Scholar 

  5. Seshadri RA, Thammaiah SK, Vaidhyalingam V (2011) Modified technique of stapled esophagojejunostomy without a purse-string suture. Indian J Surg Oncol 2:189–192

    Article  PubMed  PubMed Central  Google Scholar 

  6. Son S-Y, Cui L-H, Shin H-J, Byun C, Hur H, Han S-U, Cho YK (2017) Modified overlap method using knotless barbed sutures (MOBS) for intracorporeal esophagojejunostomy after totally laparoscopic gastrectomy. Surg Endosc 31:2697–2704

    Article  PubMed  Google Scholar 

  7. Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc 23:2624–2630

    Article  PubMed  Google Scholar 

  8. Kinoshita T, Oshiro T, Ito K, Shibasaki H, Okazumi S, Katoh R (2010) Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy. Surg Endosc 24:2908–2912

    Article  PubMed  Google Scholar 

  9. Kunisaki C, Makino H, Oshima T, Fujii S, Kimura J, Takagawa R, Kosaka T, Akiyama H, Morita S, Endo I (2011) Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy. Surg Endosc 25:1300–1305

    Article  PubMed  Google Scholar 

  10. So KO, Park J-M (2011) Totally laparoscopic total gastrectomy using intracorporeally hand-sewn esophagojejunostomy. J Gastric Cancer 11:206–211

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chen K, Pan Y, Cai J-Q, Wu D, Yan J-F, Chen D-W, Yu H-M, Wang X-F (2016) Totally laparoscopic versus laparoscopic-assisted total gastrectomy for upper and middle gastric cancer: a single-unit experience of 253 cases with meta-analysis. World J Surg Oncol 14:96

    Article  PubMed  PubMed Central  Google Scholar 

  12. Huscher CGS, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C (2007) Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg 194:839–844. [discussion 844]

    Article  PubMed  Google Scholar 

  13. Kunisaki C, Makino H, Takagawa R, Kimura J, Ota M, Ichikawa Y, Kosaka T, Akiyama H, Endo I (2015) A systematic review of laparoscopic total gastrectomy for gastric cancer. Gastric Cancer 18:218–226

    Article  PubMed  Google Scholar 

  14. Memon MA, Khan S, Yunus RM, Barr R, Memon B (2008) Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc 22:1781–1789

    Article  PubMed  Google Scholar 

  15. Zeng Y-K, Yang Z-L, Peng J-S, Lin H-S, Cai L (2012) Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 256:39–52

    Article  PubMed  Google Scholar 

  16. Chen K, He Y, Cai J-Q, Pan Y, Wu D, Chen D-W, Yan J-F, Maher H, Mou Y-P (2016) Comparing the short-term outcomes of intracorporeal esophagojejunostomy with extracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. BMC Surg 16:13

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ikeda Y, Minagawa S, Koyanagi N, Tateishi H, Sugimachi K (1997) Esophagojejunostomy with manual single layer suturing after a total gastrectomy for gastric cancer. J Surg Oncol 66:127–129

    Article  PubMed  CAS  Google Scholar 

  18. Chen K, Pan Y, Cai J-Q, Xu X-W, Wu D, Yan J-F, Chen R-G, He Y, Mou Y-P (2016) Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: a single-center 7-year experience. World J Gastroenterol 22:3432–3440

    Article  PubMed  PubMed Central  Google Scholar 

  19. Liakakos T (2011) Totally laparoscopic total gastrectomy and the challenge of esophagojejunostomy. Surg Endosc 25:3468–3469. [author reply 3470–3471]

    Article  PubMed  Google Scholar 

  20. Ito H, Inoue H, Odaka N, Satodate H, Onimaru M, Ikeda H, Takayanagi D, Nakahara K, Kudo SE (2014) Evaluation of the safety and efficacy of esophagojejunostomy after totally laparoscopic total gastrectomy using a trans-orally inserted anvil: A single-center comparative study. Surg Endosc 28:1929–1935

    Article  PubMed  Google Scholar 

  21. Jeong O, Ryu SY, Zhao XF, Jung MR, Kim KY, Park YK (2012) Short-term surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma: experience at a large-volume center. Surg Endosc 26:3418–3425

    Article  PubMed  Google Scholar 

  22. Kim HS, Kim BS, Lee S, Lee IS, Yook JH, Kim BS (2013) Reconstruction of esophagojejunostomies using endoscopic linear staplers in totally laparoscopic total gastrectomy: report of 139 cases in a large-volume center. Surg Laparosc Endosc Percutan Technol 23:e209-216

    Article  Google Scholar 

  23. Kim JH, Choi CI, Kim DI, Kim DH, Jeon TY, Kim DH, Park DY (2015) Intracorporeal esophagojejunostomy using the double stapling technique after laparoscopic total gastrectomy: a retrospective case-series study. World J Gastroenterol 21:2973–2981

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kitagami H, Morimoto M, Nakamura K, Watanabe T, Kurashima Y, Nonoyama K, Watanabe K, Fujihata S, Yasuda A, Yamamoto M, Shimizu Y, Tanaka M (2016) Technique of Roux-en-Y reconstruction using overlap method after laparoscopic total gastrectomy for gastric cancer: 100 consecutively successful cases. Surg Endosc 30:4086–4091

    Article  PubMed  Google Scholar 

  25. Lee T-G, Lee I-S, Yook J-H, Kim B-S (2017) Totally laparoscopic total gastrectomy using the overlap method; early outcomes of 50 consecutive cases. Surg Endosc 31:3186–3190

    Article  PubMed  Google Scholar 

  26. Nagai E, Ohuchida K, Nakata K, Miyasaka Y, Maeyama R, Toma H, Shimizu S, Tanaka M (2013) Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: Inverted T-shaped anastomosis using linear staplers. Surgery 153:732–738

    Article  PubMed  Google Scholar 

  27. Shida A, Mitsumori N, Fujioka S, Takano Y, Iwasaki T, Takahashi N, Ishibashi Y, Omura N, Yanaga K (2016) Comparison of short-term and long-term clinical outcomes between laparoscopic and open total gastrectomy for patients with gastric cancer. Surg Laparosc Endosc Percutan Technol 26:319–323

    Article  Google Scholar 

  28. Song JH, Choi YY, An JY, Kim DW, Hyung WJ, Noh SH (2015) Short-term outcomes of laparoscopic total gastrectomy performed by a single surgeon experienced in open gastrectomy: review of initial experience. 15:159–166

  29. Tsunoda S, Okabe H, Obama K, Tanaka E, Hisamori S, Kinjo Y, Sakai Y (2015) Short-term outcomes of totally laparoscopic total gastrectomy: Experience with the first consecutive 112 cases. World J Surg 38:2662–2667

    Article  Google Scholar 

  30. Wang H, Hao Q, Wang M, Feng M, Wang F, Kang X, Guan WX (2015) Esophagojejunostomy after laparoscopic total gastrectomy by OrVil™ or hemi-double stapling technique. World J Gastroenterol 21:8858–8867

    Article  CAS  Google Scholar 

  31. Tsukada T, Kaji M, Kinoshita J, Shimizu K (2016) Use of barbed sutures in laparoscopic gastrointestinal single-layer sutures. JSLS 20:e2016.00023

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This study was supported by Project Grants of Zhejiang Provincial Department of health (Grant No. Y2015ZDA019) and Natural Science Foundation of Zhejiang Province (Grant No. Y15H160027 and No. Y15H160030). We appreciate the voice work for video by Alex Blair who worked at the department of HPB surgery, Johns Hopkins hospital.

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Author notes

    Affiliations

    1. Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People’s Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China

      Xiaowu Xu, Chaojie Huang, Yiping Mou, Renchao Zhang & Chao Lu

    2. Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China

      Yu Pan

    3. School of Medicine, Zhejiang University, Hangzhou, 310029, Zhejiang, China

      Ke Chen

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    1. Xiaowu Xu
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    Correspondence to Yiping Mou.

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    Xiaowu Xu, Chaojie Huang, Yiping Mou, Renchao Zhang, Yu Pan, Ke Chen, and Chao Lu have no conflicts of interest or financial ties to disclose.

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    Xiaowu Xu and Chaojie Huang have contributed equally to this work.

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    Xu, X., Huang, C., Mou, Y. et al. Intra-corporeal hand-sewn esophagojejunostomy is a safe and feasible procedure for totally laparoscopic total gastrectomy: short-term outcomes in 100 consecutive patients. Surg Endosc 32, 2689–2695 (2018). https://doi.org/10.1007/s00464-017-5964-4

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    • DOI: https://doi.org/10.1007/s00464-017-5964-4

    Keywords

    • Laparoscopy
    • Esophagojejunostomy
    • Hand sewn