A Modified Anastomosis Technique for Esophagojejunostomy after Laparoscopy-Assisted Total Gastrectomy: A Single Team Preliminary Experience

Abstract

Background and objectives. Laparoscopic total gastrectomy has developed rapidly in recent years. End-to-side Roux-en-Y esophagojejunostomy by using a circular stapler is a widely accepted reconstruction method, with low rates of anastomotic complications. However, although seldom reported, difficulty of stapler insertion sometimes occurs during operation because of the small diameter of the jejunum, and that will increase the risk of anastomotic leakage or stenosis. Herein, we describe a modified technique for esophagojejunostomy which can make the insertion of the stapler easier. Patients and methods. In this retrospective study, 112 patients who had undergone laparoscopiy-assisted total gastrectomy (LATG) with D2 lymphadenectomy were examined between January 2016 and December 2020. All of these operations were performed by the same surgeon team. Of these, 44 received a conventional Roux-en-Y end-to-side esophagojejunostomy (cRY) group, and the remaining 68 underwent pant-shaped Roux-en-Y esophagojejunostomy (pRY). Clinicopathological characteristics, surgical outcomes, and postoperative complications were compared between the groups. Results. There were no significant differences between the cRY group and pRY group regarding age, sex, BMI, neoadjuvant therapy, preoperative comorbidities, history of laparotomy, ASA score, tumor location, pathological stage, total operative time, incision length, blood loss, time-to-first flatus, time-to-first soft diet, and postoperative hospital stays. The proportions of patients who received a 21 mm stapler were higher in the cRY group (7/44) than that in the pRY group (0/68) ( $P=0.003$ ). 7 anastomotic complications were reported (6 in the cRY group versus 1 in pRY group; $P=0.028$ ) of which five (83.3%) in the cRY were anastomotic stenosis versus none in the pRY group ( $P=0.044$ ). Conclusions. The application of pant-shaped anastomosis for esophagojejunostomy after LTG is a safe and feasible procedure and has an advantage when the jejunum diameter is small.