A Simple and Safe T-Shaped Esophagojejunostomy for Laparoscopic Total Gastrectomy

Background: In laparoscopic total gastrectomy, esophago-jejunal anastomosis is still considered a complicated procedure, even though laparoscopic surgery has become widespread. Esophagojejunostomy leakage can be fatal and adversely affect postoperative cancer treatment. The leakage rate has been reported to be 2.4-5.5%, and a safer and more reliable technique needs to be established. In this multi-media article, we describe the technique of laparoscopic esophagojejunostomy using a simple and safe T-shaped esophagojejunostomy.

Methods: We performed laparoscopic total gastrectomy with ante-colic Roux-en-Y reconstruction using a T-shaped anastomosis. First, insertion holes are made on the right side of the esophageal stump and the opposite side of the mesentery of the lift-up jejunal stump. Second, a linear stapler is inserted into each insertion hole, and a 40-45-mm V-shaped esophageal jejunal anastomosis is performed. Third, three temporary sutures are added for closing the common edge. Finally, a second stapling is used to close the entry hole and resect the esophageal stump.

Results: We performed this procedure in 35 patients between May 2016 and December 2018. The median duration of surgery was 338 min (range, 248-542 min) and median bleeding was 20 mL (range, 0-240 mL). There were no esophagojejunostomy-related complications higher than Clavien-Dindo grade II. Additionally, no postoperative stenosis occurred during the follow-up period (median: 48 months, range: 4-68 months).

Conclusion: Considering the present results, T-shaped esophago-jejunal anastomosis is a simple and safe procedure and a promising laparoscopic total gastrectomy option.