A novel, easier and safer alternative method for oesophagojejunal reconstruction after totally laparoscopic total gastrectomy.

Autor: Aslan M; Surgical Oncology Consultant, Department of Surgical Oncology, VM Medicalpark Hospital, Kocaeli, Turkey. ege_mehmetaslan@hotmail.com.; Tüysüzler Mahallesi, gülibrişim Sokak, No: 16/b1, Kıbrıs villaları 3. Etap 41100 İzmit, Kocaeli, Turkey. ege_mehmetaslan@hotmail.com., Topgül K; Department of General Surgery, VM Medicalpark Hospital, Kocaeli, Turkey.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 May; Vol. 37 (5), pp. 4075-4083. Date of Electronic Publication: 2023 Mar 23.
DOI: 10.1007/s00464-023-09992-x
Abstrakt: Background: This study presents a novel laparoscopic modified overlapping oesophagojejunostomy anastomosis method which consists of self-pulling and latter transection to perform a safer anastomosis, describes the anastomosis technique in detail and reveals its short-term outcomes.
Methods: Forty-five patients underwent totally laparoscopic total gastrectomy using the self-pulling and oesophagus latter-cut overlap method anastomosis for gastric cancer from January 2019-2022. During the self-pulling phase, the oesophagus was ligated at the level of the gastroesophageal junction or above and dragged down by a ligature rope to mobilise up to 5-6 cm. An entry hole was created on the right side of the oesophagus, and a nasogastric tube was taken out through the hole and tip of the tube was used as a guide for the endoscopic linear stapler to decrease the risk of entering the false lumen and creating a side-to-side anastomosis. The oesophagus was then latter-transected by a second endoscopic linear stapler. The common entry hole was closed using a hand-sewing method. Clinicopathological characteristics and surgical outcomes were collected and retrospectively evaluated.
Results: The mean anastomosis duration was 27 min. The morbidity rate was 4.4%. Only two patients experienced postoperative complications but subsequently recovered conservatively. None of the patients suffered anastomotic leak or stricture.
Conclusions: Self-pulling and latter transection-based overlapping anastomosis is a simple and reliable approach that overcomes most of the limitations of standard overlap method and provides satisfactory surgical outcomes.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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