Modified Entry Hole Closure Method for Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy: A Safe, Repeatable Method Using a Barbed Suture

Totally laparoscopic total gastrectomy (TLTG) has not been widely used to date because of the risk of postoperative complications and difficulty in reconstructing the digestive tract. To address these issues, a modified esophagojejunostomy technique in TLTG was developed. This technique reduced the need for linear staplers by effectively using a barbed suture and made closing the entry hole faster and safer. It was referred to as the modified esophagojejunostomy entry hole suture technique. A knot-free automatic suture device made of barbed suture material is used. This barbed suture was used to close the full thickness of the common opening, reinforce the seromuscular layer, and embed the esophageal stump, serving as a modified method of closing the entry hole of esophagojejunostomy in TLTG. Retrospectively, data, including surgical results and postoperative outcomes, were collected from 38 patients who underwent TLTG at the First Affiliated Hospital of Soochow University between January 2017 and December 2024. All surgeries were performed successfully. The mean operation time was 221.03 min (range 170-360 min), the mean suture time for closing the entry hole of esophagojejunostomy was 13.15 min (range 9.25-19.22 min), and the mean estimated blood loss was 96.05 mL (range 50-300 mL). The patients tolerated a liquid diet for 4.50 days (±1.87 days) after surgery, and the mean total hospital stay was 12.54 days (range 10-59 days). Overall, 6 patients underwent postoperative blood transfusion. No anastomotic-related complications or surgical complications occurred, and only 1 patient developed pneumonia after surgery. In conclusion, this modified overlap method in TLTG provides satisfactory surgical results and overcomes several technical difficulties, which is encouraging and worth expanding. This indicates that the modified method for closing the entry hole of esophagojejunostomy (E-J) in TLTG is a safe and reproducible technique.