Article

Technique and Outcomes of Laparoscopic-combined Linear Stapler and Hand-sutured Side-to-Side Esophagojejunostomy With Roux-en-Y Reconstruction as a Treatment Modality in Patients Undergoing Proximal Gastrectomy for Benign and Malignant Disease of the Gastroesophageal Junction.

Surgical laparoscopy, endoscopy & percutaneous techniques (Impact Factor: 0.94). 02/2014; 24(1):89-93. DOI: 10.1097/SLE.0b013e31828f673d
Source: PubMed

ABSTRACT Circular stapler and hand-sutured esophagojejunostomy has been the most popular technique utilized in patients undergoing proximal gastrectomy through Roux-en-Y reconstruction for disease processes of the gastroesophageal junction. In recent years, with the advent of laparoscopic bariatric surgical techniques and refined linear stapler cutters, surgeons have developed the linear stapler side-to-side technique as a valid option. The aim of this study is to describe our technique and review the outcomes using the Roux-en-Y reconstruction with linear staplers after laparoscopic proximal gastrectomy for malignant and benign disease.
After Internal Review Board approval and with adherence to the Health Insurance Portability and Accountability Act guidelines, a retrospective review of a prospectively collected database was conducted. A total of 14 patients underwent proximal laparoscopic gastric resection at our institution during a 3-year period from January 2008 to January 2011. Sex, body mass index, prior surgeries, complications of the prior surgery, intraoperative complications, pathologic findings, postoperative complications, hospital stay, and outpatient follow-up were measured in the preoperative and postoperative period.
Our patient population consisted of 9 women and 5 men, with a mean age and body mass index of 45.42 years and 35.64 kg/m, respectively. Indications for proximal gastrectomy was in 4 patients a leak at the angle of His secondary to sleeve gastrectomy for morbid obesity, 1 patient was a stricture after a vertical banded gastroplasty, 1 patient a revision of a eroded gastric band, 1 patient a revision of a eroded mesh secondary to a hiatal hernia repair, 1 patient a conversion of a failed Nissen, 3 patients had a total gastrectomy due to a stage 2 gastric cancer, and 1 patient a gastrointestinal stromal tumor. There were no intraoperative complications. All the procedures were completed laparoscopically. The mean operative time was 137.16 minutes. The mean hospital stay was 7.6 days. One patient had a postoperative stricture at the esophagojejunal anastomosis that required multiple dilatations. All patients with gastric cancer are free of tumor recurrence.
The use of a laparoscopic proximal gastrectomy with Roux-en-Y reconstruction through combined side-to-side linear stapler and hand-sewn esophagojejunal anastomosis seems to be a feasible and safe approach.

1 Follower
 · 
146 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the performance of a stapled transabdominal esophagojejunostomy there are two main technical problems involved and related to a difficult surgical exposure. One is the placement of the purse-string suture and the second is the insertion of the anvil of the circular intraluminal stapler into the distal esophagus. These technical difficulties can be overcome by opening just the anterior wall of the esophagus at the anastomosis level, leaving the posterior wall intact. The integrity of the posterior wall avoids retraction of the mucosa, allowing the esophagus to remain opened for the placement of a through and through purse-string suture under direct vision. It also acts as a conduit for the insertion of the anvil of the circular intraluminal stapler. The technique described herein avoids stay sutures, purse-string instruments, and forceful instrumental dilatation of the distal esophagus, making these very important operative steps much easier, safer, and more reliable.
    The American Journal of Surgery 08/1997; 174(1):61-2. DOI:10.1016/S0002-9610(97)00028-7 · 2.41 Impact Factor
  • Japanese Journal of Clinical Oncology 02/2004; 34(1):58. · 1.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We analyzed our preliminary clinical data for totally laparoscopic gastrectomy (TLG) in order to evaluate its effectiveness in terms of minimal invasiveness, technical feasibility, and safety. Forty-five consecutive patients who underwent TLG in our institution between June 2004 and February 2006 were enrolled in this study. There were 26 men and 19 women, with a mean age of 58.8 years and a mean body mass index (BMI) of 23.2. In all cases, only laparoscopic linear staplers were used for intracorporeal anastomosis. The reasons that gastrectomy was performed were adenocarcinoma in 41 cases, benign disease in three cases and gastrointestinal stromal tumor in one case, and the types of surgery were distal gastrectomy (40), total gastrectomy (four) and pylorus-preserving gastrectomy (one). Among the distal gastrectomies, Billroth I (25) was the most frequent procedure, followed by uncut Roux-en-Y gastrojejunostomy (14) and Billroth II (one), respectively. The mean operation time was 314 minutes, the mean anastomotic time was 41 minutes, the mean number of staples used was eight, and the mean estimated blood loss was 150 ml. There was no case of conversion to an open procedure. The first flatus was observed at 2.9 days, and liquid diet was started at 3.7 days. The mean number of postoperative analgesic use, except for patient-controlled analgesia (PCA), was 1.4 times, and the mean postoperative hospital stay was 11 days. Postoperative complication occurred in six patients (13.3 %), but no postoperative mortality occurred. There were two cases of delayed gastric empting and one case of anastomotic leakage, anastomotic stenosis, intraabdominal bleeding, and ventral hernia each. All of the patients recovered well with conservative or surgical management. TLG with intracorporeal anastomosis using laparoscopic linear staplers was safe and feasible, and we were able to obtain acceptable surgical outcomes in terms of minimal invasiveness.
    Surgical Endoscopy 03/2008; 22(2):436-42. DOI:10.1007/s00464-007-9446-y · 3.31 Impact Factor

Full-text

Download
7 Downloads
Available from
Jan 22, 2015