Intracorporeal esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy for upper gastric cancer

Background: Totally laparoscopic distal gastrectomy gained wide popularity in recent years. Laparoscopic total gastrectomy with intracorporeal esophagojejunostomy (LTGIE) is much less performed. In this study, we reported our preliminary experience of LTGIE using the transorally inserted anvil (OrVil).

Methods: Clinical data of patients with upper gastric cancer who underwent LTGIE from January 2016 to January 2017 were retrospectively collected. The operative time, intraoperative blood loss, postoperative recovery time of intestinal function, the length of hospitalization and postoperative complications were summarized and compared between early and later cases.

Results: There were totally 26 patients underwent LTGIE using OrVil successfully. The mean total operation time and esophagojejunostomy time was 272.8 min and 45.3 min. The mean estimated blood loss was 113.8 ml. The mean first flatus time was 3.1±0.9 days and the postoperative length of hospitalization (LOH) was 13.0±6.4 days. Three patients suffered postoperative complications, including one abdominal fluid collection, one pulmonary embolism and one pulmonary infection. During the follow-up period, neither local recurrence nor anastomosis-related morbidity was observed.

Conclusions: The LTGIE using OrVil is feasible and safe for upper gastric cancer. These preliminary results warrant further evaluation in a larger population to validate.