Creation of a Jejunal Pouch During Laparoscopic Total Gastrectomy and Roux-en-Y Esophagojejunostomy



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.

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Correspondence to Marc A. Ward.

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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

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  • Gastric Cancer
  • Total Gastrectomy
  • Circular Stapler
  • Laparoscopic Total Gastrectomy
  • CDH1 Gene