Intracorporeal End-to-Side Esophagojejunostomy Using a Laparoscopic Purse-String Clamp during Laparoscopic Total Gastrectomy

ABSTRACT

PURPOSE: Because no effective methods for performance of anastomosis have been established, use of laparoscopic total gastrectomy (LTG) has not been widely accepted. We aimed to establish the feasibility of using a newly developed purse-string suture instrument ("Lap-Jack"), which can be used in performance of intracorporeal anastomosis. METHODS: From April, 2010 to February, 2011, 50 patients with upper gastric cancer underwent LTG with intracorporeal Roux-en-Y esophagojejunostomy using the Lap-Jack. Retrospective data for gender, age at the time of surgery, past medical history, operative time, estimated blood loss, TNM staging, and postoperative complications were reviewed. RESULTS: Among the 50 patients, 33 were male and 17 were female. Median age was 59.9 years. The average operative time was 217.4+/-41.7 minutes. Based on the AJCC 7th edition of Gastric Cancer Staging, 19 patients were stage IA, three patients were IB, 12 patients were II, one patient was IIIA, three patients were IIIB, eight patients were IIIC, and two patients were IV. The overall morbidity rate was 18.0% without any mortality. Complications included wound problems (2.0%, n=1), pleural effusion (2.0%, n=1), urinary retention (4.0%, n=2), efferent loop obstruction due to adhesion (4.0%, n=2), postoperative ileus (2.0%, n=1), postoperative bleeding (2.0%, n=1), and intra-abdominal abscess (2.0%, n=1). No leakage or stenosis of esophagojejunostomy was reported. CONCLUSION: The Lap-Jack is feasible and suitable for use in performance of esophagojejunostomy during LTG.