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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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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References

  1. 1.

    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.

  2. 2.

    Lehnert T, Buhl K. Techniques of reconstruction after total gastrectomy for cancer. Br J Surg. 2004;91:528–64.

  3. 3.

    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.

  4. 4.

    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.

  5. 5.

    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.

  6. 6.

    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.

  7. 7.

    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.

  8. 8.

    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.

  9. 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.

  10. 10.

    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.

  11. 11.

    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.

  12. 12.

    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.

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Disclosure

There are no conflicts of interest.

Author information

Correspondence to Marc A. Ward.

Electronic supplementary material

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Supplementary material 1 (MOV 309819 kb)

Supplementary material 1 (MOV 309819 kb)

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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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Keywords

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