A modified method of laparoscopic side-to-side esophagojejunal anastomosis: report of 14 cases

Background  Alimentary tract reconstruction after laparoscopic total gastrectomy is a technical challenge. Although feasible, reconstruction through a small incision has several drawbacks. The authors therefore report a modified method of laparoscopic side-to-side esophagojejunal anastomosis developed at their hospital. Methods  The side to side esophagojejunal anastomosis was completed with a endo-GIA firing, followed by transection of the jejunum and esophagus with another firing of endo-GIA. Results  This modified procedure was performed successfully for 14 patients with gastric cancer. The mean operation time for this procedure was 42.5 ± 10.2 min. No postoperative death, fistula, or hemorrhage occurred. All the patients were followed up for a mean period of 14.5 months with no cancer recurrence at the anastomosis or anastomotic stricture. All the patients had a barium swallow test 6–2 months after the operation. The mean maximum diameter of the anastomosis was 3.8 cm (range, 3.0–4.2 cm). Four patients experienced temporary symptoms of dumping syndrome or dysphagia, which disappeared 6 months postoperatively. Conclusion  The authors consider this modified laparoscopic side-to-side esophagojejunal anastomosis to be safe, less challenging, and more economical, providing an alternative for alimentary tract reconstruction after laparoscopic total gastrectomy.