Technique of Roux-en-Y reconstruction using overlap method after laparoscopic total gastrectomy for gastric cancer: 100 consecutively successful cases

Even for expert surgeons, esophagojejunostomy after laparoscopic total gastrectomy (LTG) is not always easy to perform. Herein, we compare various types of esophagojejunostomy in terms of the technical aspects and postoperative outcomes. A total of 48 patients underwent LTG for gastric cancer by the same surgeon. Four types of intracorporeal esophagojejunostomies have been applied after LTG: type A, a conventional anvil head method; type B, an OrVil™ system method; type C, a hemi-double stapling technique with anvil head; and type D, side-to-side esophagojejunostomy with linear stapler. We describe and review these types of esophagojejunostomy using a step-by-step approach. The mean reconstruction times were longer for types A and B than for types C and D (p < 0.05). In terms of complications, there were five cases (10.4%) of anastomosis leakage, which was more common in types A and B: two cases in each of type A and B and one case in type C. Moreover, anastomosis stricture requiring intervention was more common in types A and B (p < 0.05). To date, there are no reliable reconstruction methods after LTG. Therefore, special care is needed to prevent postoperative complication regardless of methods; also, technical innovations to support development of the safest methods of esophagojejunostomy are warranted.

Laparoscopic distal gastrectomy is an accepted option for gastric cancer surgery; however, laparoscopic total gastrectomy (LTG) is not widely performed. There is concern about the safety of the operation due to the difficulty of extracorporeal reconstruction through a mini-laparotomy. Efforts have been made to establish an intracorporeal anastomotic technique for esophagojejunostomy. This article reviews the current techniques available for laparoscopic esophagojejunostomy and their surgical outcomes. Several different techniques using either circular or linear staplers have been reported; however, the apparent superiority of any particular method has not been confirmed. The incidence of anastomosis-related complications varied among studies, but different techniques all successfully achieved excellent outcomes. The overall complication rate of LTG was similar to that of open total gastrectomy, suggesting that LTG is a safe and feasible option. However, the feasibility of LTG with D2 lymph node dissection for advanced upper gastric cancer needs to be confirmed in further studies, because most of the patients included in the LTG studies were diagnosed with early stages of disease.