Completely laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomy

Abstract

Proximal gastrectomy with gastroesophagostomy or jejunal interposition is being performed widely in Japan for early-stage gastric neoplasm in the upper portion of the stomach. Its frequent use is partially attributable to the improved postoperative fat absorption, nutrition, and release of gut hormones associated with the procedure as compared with total gastrectomy. Whether gastroesophagostomy or jejunal interposition should be selectively performed after proximal gastrectomy is a controversial matter of opinion. Although gastroesophagostomy is a simple, easy, and safe procedure, it results in a high incidence of reflux esophagitis. In this respect, jejunal or jejunal pouch interposition is superior to gastroesophagostomy as a followup procedure to proximal gastrectomy. Recently, to achieve less invasive surgery, laparoscopic distal partial gastrectomies have been performed. Although the laparoscopy-assisted proximal gastrectomy with gastroesophagostomy was previously reported, no studies have reported laparoscopic proximal gastrectomy with jejunal interposition. Such a lack of studies is likely caused by the procedure’s technical difficulty. We successfully performed completely laparoscopic proximal gastrectomy with jejunal interposition using a functional end to end anastomotic technique. We describe our new procedure and the initial clinical results in this article. METHODS