Esophagus two-step-cut overlap method in esophagojejunostomy after laparoscopic gastrectomy

Area of Science:

• Gastrointestinal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Esophagojejunostomy is a critical and complex step in laparoscopic gastrectomy.
• The conventional overlap method, while feasible, presents technical limitations.
• Addressing these limitations is crucial for improving patient outcomes in gastric cancer surgery.

Purpose of the Study:

• To present novel modifications to the overlap method for esophagojejunostomy.
• To overcome specific technical disadvantages associated with the standard overlap technique.
• To evaluate the safety and efficacy of the modified approach in gastric cancer patients.

Main Methods:

• A modified overlap method, termed "esophagus two-step-cut overlap method," was applied in 48 gastric cancer patients.
• Key modifications included esophageal rotation, two-thirds transection, harmonic ultrasonic scalpel use, and posterior esophagojejunostomy.
• Reconstruction involved a linear stapler and hand-sewn closure of the entry hole.

Main Results:

• A single patient (2.1%) experienced esophagojejunal anastomotic leakage, successfully managed conservatively.
• No instances of anastomotic bleeding or stricture were reported in the study cohort.
• The modified technique demonstrated favorable short-term outcomes.

Conclusions:

• The modified overlap method offers satisfactory surgical results for esophagojejunostomy.
• This technique effectively addresses limitations like false lumen entry and unintended stapling.
• The modified approach enhances safety and feasibility in laparoscopic gastrectomy for gastric cancer.