Laparoscopic proximal gastrectomy with oblique jejunogastrostomy

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Minimally Invasive Surgery

Background:

• Proximal early gastric cancer is often treated with totally laparoscopic proximal gastrectomy (TLPG) and double-tract reconstruction (DTR).
• A potential drawback is that most dietary intake may bypass the remnant stomach, diminishing functional benefits.
• Improvements to DTR aim to facilitate passage through the remnant stomach.

Purpose of the Study:

• To introduce a novel technique for intracorporeal DTR using linear staplers following TLPG.
• To evaluate the surgical and postoperative outcomes of this technique.

Main Methods:

• A modified DTR technique using only linear staplers was employed.
• An oblique side-to-side jejunogastrostomy was created to promote passage through the remnant stomach.
• Ten patients undergoing TLPG with DTR between 2011 and 2016 were retrospectively analyzed.

Main Results:

• The median operation time was 285 minutes, with no intraoperative complications or need for blood transfusion.
• All patients had pT1N0M0 stage IA disease and experienced no anastomotic leakage.
• Postoperative imaging confirmed contrast mainly flowing into the remnant stomach, with average weight loss of 14.0% and hemoglobin decrease of 5.4% at 10-12 months.

Conclusions:

• The novel intracorporeal DTR technique using linear staplers is advantageous.
• This method facilitates dietary passage to the remnant stomach after laparoscopic proximal gastrectomy (LPG).