Laparoscopic intracorporeal stapling of the gastric tube on the basis of surface blood supply after minimally invasive esophagectomy

Abstract

Background/IntroductionMinimally invasive esophagectomy is a complex operation in which creating a healthy gastric substitute is crucial. The present study evaluated a novel method of reconstructing the intracorporeal laparoscopic gastric tube on the basis of surface blood supply to the stomach. PurposeTo study the feasibility and safety of a novel method of laparoscopic gastric tube reconstruction. MethodsAfter the complete mobilization of the stomach, the stomach was intracorporeally stapled along the watershed area between the blood supplies of the lesser and greater curvatures. Subsequently, the gastric tube was pulled up to the neck for end-to-side cervical esophagogastrostomy. Perioperative data were prospectively collected for the first 20 patients who had undergone this novel laparoscopic gastric reconstruction at our institute. The descriptive statistics are reported in this paper. ResultsWe enrolled 20 patients (18 men and 2 women) with esophageal cancer who were admitted to the Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan between January 2013 and December 2013. The mean operative time was 7.10 ± 1.08 hours, and the mean operative blood loss was 118.00 ± 79.71 mL. The average length of the gastric tubes above the sternal notch was 7.65 cm (∼5.0–15.0 ± 2.40 cm); the average width of the gastric tubes was 3.74 ± 0.47 cm. No case required conversion to open surgery, and only one patient (5%) experienced a minor anastomotic leak. The overall complication rate was 45% (predominantly involving postoperative transient hoarseness), and no surgical mortality was observed in this study. ConclusionTotal laparoscopic intracorporeal gastric tube reconstruction based on anatomical characteristics of the surface blood supply to the stomach is safe and feasible.