Left colon substitution with His' angle following total gastrectomy. Surgical technique using stapling devices

Area of Science:

• Gastroenterology
• Surgical Oncology
• Surgical Innovation

Background:

• Jejunal Roux-en-Y reconstruction after total gastrectomy presents several disadvantages.
• Esophagitis due to regurgitation is a common complication.
• Alternative reconstruction methods are needed to improve patient outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of left colon substitution for gastrointestinal reconstruction following total gastrectomy.
• To assess the technique's ability to prevent complications such as regurgitation and anastomotic issues.
• To determine the impact on patient nutrition and weight post-surgery.

Main Methods:

• A novel technique involving left colon interposition between the remnant esophagus and duodenum was developed.
• Mechanical stapling devices were used for all three anastomoses: esophagocolic, duodenocolic, and colocolic.
• A new His' angle was created using sutures to mitigate regurgitation.

Main Results:

• Fifteen patients with gastric cancer successfully underwent the procedure without intraoperative complications.
• No instances of anastomotic leakage, colon segment necrosis, or late stricture were observed.
• Postoperative barium studies confirmed adequate colon graft capacity and passage, with no regurgitation; patients maintained satisfactory diet volume and minimal weight loss.

Conclusions:

• Left colon substitution is a safe and effective method for reconstruction after total gastrectomy.
• The technique successfully addresses the limitations of Roux-en-Y reconstruction, including reduced regurgitation and improved nutritional status.
• This approach offers a promising alternative for gastric cancer patients requiring total gastrectomy.