A modified overlap method using a linear stapler for intracorporeal esophagojejunostomy after laparoscopic total...

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Intracorporeal esophagojejunostomy is a challenging step in laparoscopic total gastrectomy (LTG).
• The novel
• overlap method
• for this procedure has known technical drawbacks.
• Modifications were developed to enhance the overlap method for easier intracorporeal esophagojejunostomy.

Purpose of the Study:

• To present a modified overlap method for intracorporeal esophagojejunostomy.
• To evaluate the safety and efficacy of this modified technique in patients undergoing LTG for gastric cancer.

Main Methods:

• A modified overlap method was applied to 54 patients undergoing LTG between October 2009 and July 2013.
• Key modifications included: 90-degree clockwise esophageal rotation during transection, side-to-side esophagojejunostomy using an endoscopic linear stapler via the right lower trocar, and closure of the stapler entry hole with intracorporeal hand-sewn continuous suturing.

Main Results:

• The modified overlap method was successfully completed in 53 out of 54 patients (98.1%).
• A single case (1.9%) of esophagojejunal anastomotic leakage occurred, which resolved with conservative management.
• No instances of postoperative anastomotic stricture or bleeding were reported.

Conclusions:

• The modified overlap method for intracorporeal esophagojejunostomy yields highly satisfactory outcomes.
• This refined technique is a viable and potentially standard approach for esophagojejunostomy following LTG.