The creation of Hunt-Lawrence jejunal pouches after total gastrectomy is associated with a better quality of life compared with the standard Roux-en-Y esophagojejunostomy. To the authors’ knowledge, this is the first video to show the technical aspects of creating a jejunal pouch during a laparoscopic total gastrectomy.
A 35-year-old woman was seen for surgical evaluation of a newly diagnosed CDH1 gene mutation. The authors recommended a laparoscopic total gastrectomy with Hunt-Lawrence pouch reconstruction. The jejunal pouch was created using an extracorporeal approach after removal of the stomach. A laparoscopic gel port was then placed over the extraction site to maintain pneumoperitoneum to facilitate a laparoscopic esophagojejunal pouch anastomosis using a circular stapler.
The patient was discharged home on postoperative day 4. Her pathology showed no gastric cancer, and all 31 lymph nodes harvested were free of malignancy. At 1 year postoperatively, she had lost 25 lb from her presurgerical weight and was maintaining a healthy body mass index of 24 kg/m2.
Hunt-Lawerence jejunal pouches have been shown to improve quality of life compared with esophagojejunostomy without pouch formation after total gastrectomy. This video shows a novel technique for jejunal pouch creation during laparoscopic total gastrectomy using a laparoscopic gel port after gastric extraction to facilitate a laparoscopic esophagojejunal pouch anastomosis.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Herrington JL Jr. Various types of pouch replacement following total gastrectomy: historical data and current thoughts regarding total gastrectomy. Am Surg. 1968;34:879–87.
Lehnert T, Buhl K. Techniques of reconstruction after total gastrectomy for cancer. Br J Surg. 2004;91:528–64.
Nakane Y, Okumura S, Akehira K, et al. Jejunal pouch reconstruction after total gastrectomy for cancer: a randomized controlled trial. Ann Surg. 1995;222:27.
Troidl H, Kusche J, Vestweber KH, Eypasch E, Maul U. Pouch versus esophagojejunostomy after total gastrectomy: a randomized clinical trial. World J Surg. 1987;11:699–712.
Iivoenen MK. Long-term follow-up of patients with jejunal pouch after total gastrectomy: a randomized prospective study. Scand J Gastroenterol. 2000;35:679–85.
Fein M, Fuchs KH, Thalheimer A, Freys SM, Heimbucher J, Thiede A. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial. Ann Surg. 2008;247:759–65.
Endo S, Nishida T, Nishikawa K, et al. Motility of the pouch correlates with quality of life after total gastrectomy. Surgery. 2006;139:493–500.
Zong L, Chen P, Chen YB, Shi G. Pouch Roux-en-Y versus no pouch Roux-en-Y following total gastrectomy: a meta-analysis based on 12 studies. J Biomed Res. 2011;25:90–9.
Haverkamp L,Weijs TJ, van der Sluis PC, van der Tweel I, Ruurda JP, van Hillegersberg R. Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and metaanalysis. Surg Endosc. 2013;27:1509–20.
Norton JA, Ham CM, Van Dam J, et al. CDH1 truncating mutations in the E-cadherin gene: an indication for total gastrectomy to treat hereditary diffuse gastric cancer. Ann Surg. 2007;245:873–9.
Gioffre’ Florio MA, Bartolotta M, Miceli JC, et al. Simple versus double jejunal pouch for reconstruction after total gastrectomy. Am J Surg. 2000;180:24–8.
Kalmar K, Cseke L, Zambo K, Hovarth OP. Comparison of quality of life and nutritional parameters after total gastrectomy and a new type of pouch construction with simple Roux-en-Y reconstruction: preliminary results of a prospective, randomized, controlled study. Dig Dis Sci. 2001;46:1791–6.
There are no conflicts of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Ward, M.A., Ujiki, M.B. Creation of a Jejunal Pouch During Laparoscopic Total Gastrectomy and Roux-en-Y Esophagojejunostomy. Ann Surg Oncol 24, 184–186 (2017) doi:10.1245/s10434-016-5540-5
- Gastric Cancer
- Total Gastrectomy
- Circular Stapler
- Laparoscopic Total Gastrectomy
- CDH1 Gene