Abstract
BackgroundDigestive tract reconstruction in totally laparoscopic total gastrectomy can be divided into two types: instrument anastomosis and hand-sewn anastomosis. This study explored the feasibility and safety of hand-sewn sutures in esophagojejunostomy of totally laparoscopic total gastrectomy, compared with instrument anastomosis using an overlap linear cutter.MethodsThis retrospective cohort study was conducted from January 2017 to January 2020 at one institution. The clinical data of 50 patients who underwent totally laparoscopic total gastrectomy, with an average follow-up time of 12 months, were collected. The clinicopathologic data, short-term survival prognosis, and results of patients in the hand-sewn anastomosis (n=20) and the overlap anastomosis (n=30) groups were analyzed.ResultsThere were no significant differences between the groups in sex, age, body mass index, American Society of Anesthesiologists score, tumor location, preoperative complications, abdominal operation history, tumor size, pTNM stage, blood loss, first postoperative liquid diet, exhaust time, or postoperative length of hospital stay. The hand-sewn anastomosis group had a significantly prolonged operation time (204±26.72min versus 190±20.90min, p=0.04) and anastomosis time (58±22.0min versus 46±15.97min, p=0.029), and a decreased operation cost (CNY 77,100±1700 versus CNY 71,900±1300, p<0.0001). Postoperative complications (dynamic ileus, abdominal infection, and pancreatic leakage) occurred in three patients (15%) in the hand-sewn anastomosis group and in four patients (13.3%) in the overlap anastomosis group (anastomotic leakage, anastomotic bleeding, dynamic ileus, and duodenal stump leakage).ConclusionThe hand-sewn anastomosis method of esophagojejunostomy under totally laparoscopic total gastrectomy is safe and feasible and is an important supplement to linear and circular stapler anastomosis. It may be more convenient regarding obesity, a relatively high position of the anastomosis, edema of the esophageal wall, and short jejunal mesentery.
Highlights
Digestive tract reconstruction in totally laparoscopic total gastrectomy can be divided into two types: instrument anastomosis and hand-sewn anastomosis
Since Kitano et al [1] first reported laparoscopicassisted Billroth I gastrectomy for early-stage gastric cancer in 1994, laparoscopic distal gastrectomy (LDG) has been accepted as a technically and oncologically feasible method [2,3,4,5]
There is no uniform standard for totally laparoscopic total gastrectomy (TLTG) due to the difficulty in digestive tract reconstruction and the diversity of anastomosis methods [6,7,8,9,10,11,12]
Summary
Digestive tract reconstruction in totally laparoscopic total gastrectomy can be divided into two types: instrument anastomosis and hand-sewn anastomosis. This study explored the feasibility and safety of hand-sewn sutures in esophagojejunostomy of totally laparoscopic total gastrectomy, compared with instrument anastomosis using an overlap linear cutter. TLTG digestive tract reconstruction can be divided into two categories: instrument anastomosis, which mainly employs a circular anastomosis technique and linear cutting, and hand-sewn anastomosis. Hand-sewn anastomosis has been reported to be a safe and feasible procedure [6,7,8,9, 13,14,15], clinical research remains insufficient. We compared the clinical results of the two groups, aiming to explore the application prospects of hand-sewn anastomosis in the evaluation of TLTG
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