Novel reconstruction method after laparoscopic total gastrectomy : Intra-Corporeal Esophagojejunostomy with Endoloop(ICEE)

BACKGROUND: Although laparoscopic distal gastrectomy has been used widely for treatment for gastric cancer, laparoscopic total gastrectomy(LTG) is still uncommon. One of the reasons is the technical difficulty of performing the esophagojejunal anastomosis, especially anvil-insertion. Various reconstruction methods have been reported, but optimal method has not been established. Based upon our experience of laparoscopic total gastrectomy, we developed very simple and safe esophagojejunal anastomosis method and we named it as Intra-Corporeal Esophagojejunostomy with Endoloop(ICEE). In this study, we compared the short outcomes of LTG reconstructed by conventional purse-string suture and by ICEE. METHODS: From January 2009 to December 2012 , LTG with intracorporeal esophagojejunostomy was performed in 62 patients at Ajou university hospital, Suwon, Korea. Among them, 35 consecutive cases with gastric cancer underwent totally laparoscopic total gastrectomy with intracorporeal anvil wrapping with loop tie without purse-string suture. After transection of the abdominal esophagus, anvil head was inserted into the distal esophagus and a laparoscopic loop tie was applied and tied to wrap the edge of the esophagus. After the creation of a Roux-en-Y jejunal limb, laparoscopic esophagojejunal anastomosis was performed by docking the body of the stapler to the anvil head. The jejunal stump was closed with a linear stapler. RESULTS: Laparoscopic esophagojejunostomy was performed successfully for all the patients. No postoperative complications related to anastomosis occurred. The mean operation time was 227.2 min, and the estimated blood loss was 155.9 ml. Complication was developed only in 3 patients with wound seroma, postoperative ileus ,intraabdominal fluid collection . And all of them were successfully treated conservatively. Mean hospital stay was 8.4 (6-12) days. CONCLUSION: This technique is feasible can lower the operation time and complications after totally laparoscopic total gastrectomy. We believe this method is most easy and safe.

Author dc:creator

• 변, 철수

Contributors dc:contributor

• 한, 상욱
• 대학원 의학과
• 105187

• laparoscopic total gastrectomy(LTG)
• esophagojejunostomy
• Anvil insertion and wrapping
• Intra-Corporeal Esophagojejunostomy with Endoloop(ICEE)
• 복강경 위 전 절제술
• anvil
• 선형문합기
• 쌈지 봉합술

Language dc:language

en

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000016869
000000016869

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/10881