Predominant classic circular-stapled double-tract reconstruction after totally laparoscopic proximal gastrectomy: safe,
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Predominant classic circular‑stapled double‑tract reconstruction after totally laparoscopic proximal gastrectomy: safe, feasible, time‑saving anastomoses by technical tie‑up Jian Hu1 · Lizhi Zhao2 · Hongyuan Xue1,3 · Ziqiang Zhang1,3 · Jianjun Du1 Received: 15 January 2020 / Accepted: 10 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The double-tract reconstruction (DTR) could be a preferable option in avoiding the postoperative esophageal reflux and anastomotic stenosis during totally laparoscopic proximal gastrectomy (TLPG). An optimal procedure to achieve the DTR in TLPG remains to be established. Methods During March 2018 to April 2019, 15 consecutive patients with gastric cancer in the upper third of the stomach underwent intracorporeal DTR after TLPG at our hospital. The intracorporeal esophagojejunostomy (E-J), gastrojejunostomy (G-J) and jejunojejunostomy (J-J) were, respectively, performed using circular staplers by the Self-Pulling and Holding Purse-String Suture Technique, Intraluminal Poke Technique and U-shaped Parallel Purse-string Suture Technique (Technical Tie-Up). Demographic and clinicopathologic characteristics, perioperative details and postoperative outcomes were analyzed. Results The mean operating time was 216.1 ± 18.2 min. Total time for three anastomoses was 49.8 ± 6.1 min, and the time for E-J, G-J, J-J was 22.4 ± 5.0 min, 13 (range 11–16) min, 14.2 ± 2.8 min, respectively. The median proximal and distal resection margins were 2.5 (range 2–4) cm and 6 (range 5–7) cm, respectively, which were all tumor-free in 15 patients. No major complications and mortality occurred. During the median follow-up period of 14 months (range 7 to 20.5 months), there were no postoperative anastomosis-related complications observed, such as anastomotic bleeding, leakage or stenosis. No patients complained the symptoms indicating esophageal reflux and remnant gastritis. Conclusions Predominant classic circular-stapled double-tract reconstruction is safe, feasible and time-saving in TLPG by the technical tie-up. Keywords Circular-stapled anastomosis · Double-tract reconstruction · Laparoscopic proximal gastrectomy The incidence of cancer in the upper third of the stomach has been steadily increasing over the last half century [1, 2]. Jian Hu and Lizhi Zhao have equally contributed to this work and should be considered as co-first authors. * Jianjun Du [email protected] 1
Department of General Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai 200040, China
2
Department of Digestive Surgery, Hanzhong Central Hospital, No. 22 Kangfu Road, Hanzhong 723000, Shaanxi, China
3
Department of General Surgery, Huashan Hospital North, Fudan University, No.108 Luxiang Road, Shanghai 201907, China
For these cases of proximal gastric cancer, both laparoscopic total gastrectomy (LTG) and laparoscopic proximal gastrectomy (LPG) are the current surgical approaches, while the
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