Modified Entry Hole Closure Method for Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy: A Safe,...

Area of Science:

• Gastrointestinal Surgery
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Totally laparoscopic total gastrectomy (TLTG) presents challenges in digestive tract reconstruction and carries risks of postoperative complications.
• Existing esophagojejunostomy techniques often require complex methods and specialized instruments, limiting widespread adoption of TLTG.
• The need for improved, safer, and more efficient reconstruction methods in TLTG is critical for advancing minimally invasive oncologic surgery.

Purpose of the Study:

• To introduce and evaluate a modified esophagojejunostomy technique for TLTG utilizing barbed suture material.
• To assess the safety, feasibility, and efficacy of this modified technique in terms of surgical outcomes and postoperative complications.
• To demonstrate how this novel approach simplifies the closure of the esophagojejunostomy entry hole, reducing reliance on linear staplers.

Main Methods:

• A modified esophagojejunostomy entry hole suture technique was developed, employing a knot-free automatic suture device with barbed suture material.
• This barbed suture was used for full-thickness closure of the common opening, reinforcement of the seromuscular layer, and embedding the esophageal stump.
• A retrospective analysis of 38 patients who underwent TLTG using this modified technique between January 2017 and December 2024 was conducted.

Main Results:

• All 38 TLTG surgeries were performed successfully with no anastomotic-related or surgical complications.
• The mean operative time was 221.03 minutes, and the mean suture time for esophagojejunostomy closure was 13.15 minutes.
• Postoperative outcomes were favorable, with a mean liquid diet tolerance of 4.50 days and a mean hospital stay of 12.54 days; only one patient developed pneumonia.

Conclusions:

• The modified esophagojejunostomy overlap method in TLTG is a safe, reproducible, and effective technique.
• This approach overcomes technical difficulties associated with esophagojejunostomy reconstruction in TLTG, particularly in closing the entry hole.
• The technique's satisfactory surgical results suggest it is a valuable advancement worthy of wider implementation in minimally invasive gastric surgery.