Intracorporeal Laparoscopic Roux-en-Y Gastrojejunostomy After 95% Gastrectomy for Early Gastric Cancer in the Upper Third of the Stomach: A Report on 21 Cases

Abstract

Many reconstructive procedures have been developed in an effort to resolve complications after total gastrectomy (TG). However, anatomical disruption of the esophagogastric junction, especially the low esophageal sphincter, still occurs so that postoperative complications continue to arise. In this study, we developed a procedure for intracorporeal laparoscopic Roux-en-Y gastrojejunostomy (RYGJ) after 95% (near-total) gastrectomy, to reduce postoperative complications in early gastric cancer (EGC) of the upper third of the stomach. Laparoscopic RYGJ after 95% gastrectomy was performed on 21 patients with EGC in the upper third of the stomach between May 2011 and April 2012 in Asan Medical Center, Seoul, Korea. The resection line of the stomach was marked using metallic preoperative endoscopic clips and intraoperative laparascopic vessel clips together with a portable abdominal radiograph. Approximately 95% of the stomach was transected using an endoscopic linear stapler, and an antecolic side-to-side gastrojejunal anastomosis was created between the posterior side of the gastric remnant and the antimesenteric side of the jejunal limb, also using an endoscopic linear stapler. The entry hole was first closed in approximate fashion with three sutures, and closure was completed with an endoscopic linear stapler. Intracorporeal laparoscopic RYGJ after 95% gastrectomy was successfully performed in all patients. No patients required conversion to open surgery or other laparoscopic anastomosis techniques. No postoperative complications occurred. All patients had tumor-free resection margins, and there was no mortality. Intracorporeal laparoscopic RYGJ after 95% gastrectomy can be performed easily and safely. We recommend this method over laparoscopic TG or open TG for treatment of EGC in the upper third of the stomach.