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Related Experiment Video

Updated: Jan 30, 2026

Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
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Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy

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Current status of laparoscopic total gastrectomy.

Yoshihiko Kawaguchi1, Kensuke Shiraishi1, Hidenori Akaike1

  • 1First Department of Surgery Faculty of Medicine University of Yamanashi Chuo Yamanashi Japan.

Annals of Gastroenterological Surgery
|January 31, 2019
PubMed
Summary

Laparoscopic total gastrectomy (LTG) involves complex lymph node dissection and reconstruction. Optimal esophagojejunostomy (EJS) techniques, particularly stapler insertion sites, minimize complications like anastomotic leakage and stricture.

Keywords:
esophagojejunostomygastric cancerlaparoscopic total gastrectomylymphadenectomypostoperative complication

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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery
  • Minimally Invasive Surgery

Background:

  • Laparoscopic total gastrectomy (LTG) is a key procedure for gastric cancer.
  • Challenges in LTG include lymph node dissection and reconstruction techniques.

Purpose of the Study:

  • To review the current state of laparoscopic total gastrectomy (LTG).
  • To focus on lymph node dissection and reconstruction methods in LTG.
  • To analyze complications associated with different esophagojejunostomy (EJS) techniques.

Main Methods:

  • Review of current literature on laparoscopic total gastrectomy.
  • Analysis of lymph node dissection strategies, including splenic hilar nodes.
  • Comparison of circular stapler (CS) and linear stapler (LS) esophagojejunostomy (EJS) techniques.
  • Categorization of CS complications based on anvil insertion procedures and sites.

Main Results:

  • LTG for advanced gastric cancer requires extended lymph node dissections.
  • While prophylactic splenectomy shows no survival benefit, adequate splenic hilar lymph node dissection may be beneficial.
  • Esophagojejunostomy (EJS) complication rates (leakage, stricture) are similar between CS and LS methods.
  • For CS, inserting the anvil from the upper left abdomen resulted in the lowest complication rates, while midline umbilical insertion showed the highest.

Conclusions:

  • Surgeons must understand the nuances of lymph node dissection and EJS reconstruction in LTG.
  • Careful selection of EJS technique and stapler insertion site is crucial for minimizing complications.
  • Optimizing EJS techniques can improve patient outcomes after LTG.