Related Experiment Video
Updated: Sep 18, 2025
Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment
Published on: December 27, 2024
Overlap Versus π-Shaped Esophagojejunostomy After Laparoscopic Total Gastrectomy for Gastric Cancer: A Comparative
Luyang Zhang1, Junjun Ma1, Jingzhu Li2
1Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.
Background:
An increasing number of medical professionals are choosing to use totally laparoscopic total gastrectomy (TLTG) as a treatment option for gastric cancer. However, the optimal reconstruction method is still under debate. The objective of this study is to evaluate the immediate results of 2 intracorporeal esophagojejunostomy techniques: overlap (isoperistaltic side-to-side) (O) and pi-shaped (π) (anisoperistaltic side-to-side) anastomosis.
Methods:
Hospital records of 110 patients who underwent esophagojejunostomy (group O, n=65 or group π, n=45) after TLTG from January 2016 to December 2019 were retrospectively reviewed. The demographic and clinicopathologic characteristics, along with the surgical and pathologic results, were recorded, compared, and evaluated for immediate impacts.
Results:
The demographic characteristics of the 2 groups exhibited no significant disparities. Moreover, there were no statistically notable differences in tumor size, lymph node count, or TNM stage between the 2 groups. All surgeries were successfully completed without any complications or need for conversion to laparotomy, and there were no occurrences of postoperative mortality. In addition, there were no statistically significant variances between the 2 groups in terms of total operation time, estimated blood loss, time to first flatus, or length of postoperative hospital stay. Time for esophagojejunostomy, however, was statistically significantly shorter in group π than in group O (27.4±5.2 vs. 36.7±5.0 min) ( P <0.001). No statistically significant difference was found between the 2 groups with regard to postoperative complications: 5 grade I, 6 grade II, and 1 grade IIIa in group O (n=12) versus 5 grade I, 3 grade II, 2 grade IIIa, and 1 grade IIIb in group π (n=11). At 6-month endoscopy and oral water-soluble contrast medium follow-up, no anastomotic complication was noted.
Conclusions:
The π anastomosis is feasible, safe, with the need for fewer cartridges and is eventually a time-saving procedure for esophagojejunostomy with no hand-sewing involved. In this study, both methods have shown favorable short-term results in the treatment of gastric cancer.
