Application of the mesentery transected π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy

doi:10.3877/cma.j.issn.1674-6899.2020.04.004

Abstract

Abstract:

Objective

To explore the safety and feasibility of the mesentery transected π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy.

Methods

A retrospective study was conducted by collecting the clinicopathological data of 11 gastric cancer patients in Liyang Branch Hospital of Jiangsu Province Hospital from Oct. 2018 to Dec. 2019. All patients underwent the mesentery transected π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy. Observation indicators included: operation time, time of the mesentery transected π-shaped esophagojejunostomy, volume of intraoperative blood loss, number of dissected lymph node, duration of postoperative hospital stay, postoperative pathological examination.

Results

All the 11 patients underwent successful totally laparoscopic total gastrectomy using the mesentery transected π-shaped esophagojejunostomy, without conversion to open surgery or perioperative death. The average operation time was (264.50±33.13) minutes, time of the mesentery transected π-shaped esophagojejunostomy was (31.82±8.15) minutes, intraoperative bleeding volume was (127.30±108.10) ml, number of dissected lymph node was (53.91±19.78), the average postoperative hospital stay was(13.73±2.33)days. 11 patients were not complicated with anastomotic fistula, hemorrhage, duodenal stump fistula or death, and all recovered smoothly. Postoperative pathological examination: pTNM staging showed that stage ⅠA, ⅠB, ⅡA, ⅡB, ⅢB and ⅢC were detected in 2, 2, 4, 1, 1 and 1 patients, respectively. All 11 patients were followed up. During follow-up, no tumor recurrence, metastasis or death occurred. Endoscopy after 1 year of operation showed that the anastomoses were unobstructed without anastomotic stenosis.

Conclusions

The mesentery transected π-shaped esophagojejunostomy is safe and feasible in totally laparoscopic total gastrectomy.

Key words: Gastric tumor, Total gastrectomy, π-shaped anastomosis, Laparoscopic

Chuming Zhu, Guozhong Yao, Li Yang, Hao Fan, Hongzhi Zhang, Jianjun Wu, Jiang Yan. Application of the mesentery transected π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(04): 207-211.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2020.04.004

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2020/V13/I04/207

Figures/Tables 4

References 17

1	Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted billroth Ⅰ gastrectomy [J]. Surg Laparosc Endosc, 1994, 4(2): 146-148.
2	Kim JW, Kim WS, Cheong JH, et al. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial [J]. World J Surg, 2012, 36(12): 2879-2887.
3	杨力，徐泽宽，徐皓，等. 胃癌全腹腔镜下全胃切除食管空肠π形吻合临床体会[J]. 中华胃肠外科杂志，2016, 19(8): 948-950.
4	中华医学会外科学分会腹腔镜与内镜外科学组，中国研究型医院学会机器人与腹腔镜外科专业委员会. 腹腔镜胃癌手术操作指南(2016版) [J]. 中华消化外科杂志，2016, 15(9): 851-857.
5	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4) [J]. Gastric Cancer, 2017, 20(1): 1-19.
6	左婷婷，郑荣寿，曾红梅，等. 中国胃癌流行病学现状 [J]. 中国肿瘤临床，2017, 44(1): 52-58.
7	洪清琦，王伟，张健，等. 373例完全腹腔镜与腹腔镜辅助根治性全胃切除术疗效的多中心回顾性研究 [J]. 中华消化外科杂志，2017, 16(8): 822-827.
8	Son SY, Lee CM, Jung DH, et al. Laparoscopic completion total gastrectomy for remnant gastric cancer: a single-institution experience [J]. Gastric Cancer, 2015, 18(1): 177-182.
9	Kunisaki C, Makino H, Kimura J, et al. Application of reduced-port laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen [J]. Gastric Cancer, 2015, 18(4): 868-875.
10	Goh PM, Khan AZ, So JB, et al. Early experience with laparoscopic radical gastrectomy for advanced gastric cancer [J]. Surg Laparosc Endosc Percutan Tech, 2001, 11(2): 83-87.
11	李国新，陈新华，余江. 腹腔镜全胃切除食管空肠吻合方式安全性评价及应用 [J]. 中华消化外科杂志，2018, 17(6): 550-554.
12	黄昌明，黄泽宁．完全腹腔镜胃癌根治术后消化道重建的选择和操作要点[J/CD]．中华腔镜外科杂志(电子版)，2019，12(1): 34-36.
13	Inaba K, Satoh S, Ishida Y, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy[J]. Journal of the American College of Surgeons, 2010，211(6): 25-29.
14	Kwon IG, Son YG, Ryu SW. Novel intracorporeal esophagojejunostomy using linear staplers during laparoscopic total gastrectomy: pi-shaped esophagojejunostomy, 3-in-1 technique [J]. J Am Coll Surg, 2016, 223(3): 25-29.
15	蒿汉坤，洪军，王雅平，等. 自牵引后离断食管-空肠吻合术100例安全性评价 [J]. 中华胃肠外科杂志，2018, 21(2): 206-211.
16	杨力，徐泽宽. 腹腔镜全胃切除术后消化道重建的经验与思考[J/CD]. 中华腔镜外科杂志(电子版), 2019, 12(4): 207-212.
17	Papasavas PK, Caushaj PF, Mccormick JT, et al. Laparoscopic management of complications following laparoscopic roux-en-y gastric bypass for morbid obesity [J]. Surg Endosc, 2003, 17(4): 610-614.

病例序号	性别	年龄(岁)	体质量指数(kg/m²)	术前cTNM分期
1	女	67	23.10	T1-2N0M0
2	男	75	19.70	T1-2N0M0
3	男	60	26.80	T3-4N＋M0
4	男	69	21.24	T3-4N＋M0
5	男	73	25.76	T1-2N0M0
6	男	61	18.73	T2-3N0M0
7	男	73	17.96	T1-2N0M0
8	男	71	23.44	T2-3N0M0
9	男	64	21.72	T3-4N＋M0
10	男	70	20.71	T2-3N0M0
11	男	67	25.25	T1-2N0M0

病例序号	性别	年龄(岁)	体质量指数(kg/m²)	术前cTNM分期
1	女	67	23.10	T1-2N0M0
2	男	75	19.70	T1-2N0M0
3	男	60	26.80	T3-4N＋M0
4	男	69	21.24	T3-4N＋M0
5	男	73	25.76	T1-2N0M0
6	男	61	18.73	T2-3N0M0
7	男	73	17.96	T1-2N0M0
8	男	71	23.44	T2-3N0M0
9	男	64	21.72	T3-4N＋M0
10	男	70	20.71	T2-3N0M0
11	男	67	25.25	T1-2N0M0

[1]	Weifeng Lan, Zhijian Chen, Hanyin Hong, Jianwei Chen, Xinghua Huang, Xiaobin Chi, Yongbiao Chen. Application of indocyanine green in laparoscopic hepatectomy [J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(04): 309-312.
[2]	Ke He, Zhou Zang. Clinical analysis of the influencing factors of long-term prognosis of patients with T4 gastric cancer after laparoscopic radical operation [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(04): 404-406.
[3]	Dezhi Shao, Zhiyi Feng, Naichao Guo, Yanlin Lvy, Xiaocui Wang, Yuhao Dong. Diagnosis and treatment of 42 cases of acute acalculous cholecystitis [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(04): 434-436.
[4]	Enwen Xu, Huachun Wang. Feasibility of repair of indirect inguinal hernia with lateral umbilical ligament covering inner ring [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(04): 390-393.
[5]	Shude Chen, Peng Lu, Yipeng Lin, Zhen Yang, Wenzhi Zhang. Clinical analysis of radiofrequency ablation and laparoscopic hepaterectomy for small hepatocellular carcinoma [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(04): 201-205.
[6]	Sirao Qu, Manman Zhao, Quanhong Li, Fang Li, Jingjing Ma, Yinan Zhang, Siran Jing, Jianli Sun. Comparison of clinical efficacy of gasless vaginal natural orififice transluminal endoscopic surgery and traditional laparoscopy surgery for ovarian cyst [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(04): 217-220.
[7]	Gang Long, Yue Gao, Aidong Li, Lingwei Lyu, Zhengtian Li. Laparoscopic treatment of pancreatic pseudocyst [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(04): 248-253.
[8]	Shizhou Jiang, Ju Wang. Existing problems and strategies of visual field exposure in laparoscopic surgery [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(04): 254-256.
[9]	Junxi Xiang, Kui Yang, Guanghui Wang, Long Li, Yuelang Zhang, Yinying Wu, Wei Yang, Junjun She, Qingguang Liu, Yingmin Yao, Cheng Guo. Laparoscopic surgery for colon cancer liver metastasis and pelvic metastasis: a case report [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(04): 241-244.
[10]	Yafeng Chen, Jiangbin Li, Dong Wang, Nianan Luo, Li Zang, Jikai Yin, Jianguo Lu, Rui Dong. Application of laparoscopic splenectomy in the treatment of massive splenomegaly [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(03): 152-157.
[11]	Shuo Zhang, Jun Yang, Yuanlong Gu. Risk factors and treatments of biliary tract injury caused by laparoscopic cholecystectomy [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(05): 470-473.
[12]	Zhiming Wu, Hongjun Huang, Xingcheng Meng, Jiahao Ge, Liqing Shen, Chang'en Hu, Hong Yu. ERAS protocol in primary suture of laparoscopic common bile duct exploration [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(05): 474-478.
[13]	Tianlong Ding, Baohong Gu, Xuemei Li, Jike Hu, Fan Zhang, Zedong Feng, Bin Ma, Chen Wang, Hao Chen. Application of "stripping" technique in laparoscopic cholecystectomy [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(05): 498-501.
[14]	Yang Chen, Dong Li, Youwen Fan, Fei Huang, Qiang Tao, Yajun Tang, Liang Deng, Di Tang. Minilap-assisted two-port laparoscopic cholecystectomy: analysis of 10 cases [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(04): 414-417.
[15]	Xin Lan, Chenglin Piao, Fengduo An, Mingkun Tan, Zhenduo Si, Wei Wu, Na Zhao, Jianjun Leng. Short-term outcomes of three-dimensional vs two-dimensional laparoscopic hepatectomy for hepatocellular carcinoma [J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(05): 327-330.

Please choose a citation manager

Content to export