Overlap Anastomosis for Digestive Reconstruction during Laparoscopic Distal Gastrectomy with Intensive Regional Lymph Node Dissection: Physiological Impact of Preserving the Mesenteric Autonomic Nerves in the Lifted Jejunal Limb.

Taku Kitano,Tomohide Hori,Yuki Aisu,Daiki Yasukawa

doi:10.1155/2018/4938341

Abstract

Laparoscopic gastrectomy is a treatment for gastric cancer, and isoperistaltic side-to-side reconstruction is called “overlap anastomosis.” The physiological advantages of preserving the autonomic nerves in the jejunal limb for digestive reconstruction are well known. Here, we focused on overlap anastomosis with autonomic nerve-preserved mesojejunum of the lifted jejunal limb for laparoscopic distal gastrectomy with intentional lymph node dissection. Our surgical techniques and technical pitfalls were described in detail. The jejunum was partially sacrificed to preserve the autonomic nerves in the lifted jejunal limb. The length of the staple line was 35 – 40 mm. The endostapler entry was carefully closed to avoid even subtle stenosis. Twelve patients were retrospectively evaluated with a follow-up of 5.0 ± 0.6 years. Histological findings according to the Japanese classification were stage IA or IB. Dietary intake and postoperative ambulation occurred at 3.3 ± 1.0 and 1.3 ± 0.5 days after surgery, respectively. Postoperative complications according to Clavien–Dindo classification were one each of grade I and grade II. Postoperative hospital stay was 6.7 ± 1.6 days. Five patients were medication-free at final follow-up, with no recurrence in any patient. Overlap anastomosis with autonomic nerve-preserved jejunal limb was safe and feasible for laparoscopic distal gastrectomy with lymph node dissection.

Highlights

Laparoscopic gastrectomy for gastric cancer is currently considered safe and feasible [1]
We retrospectively evaluated our experience with overlap anastomosis with autonomic nerve-preserved mesojejunum for the lifted jejunal limb in laparoscopic distal gastrectomy with intentional regional lymph node dissection
A lifted jejunal limb is required for overlap anastomosis, and a well-designed surgery is important for successful gastrojejunostomy

Summary

Introduction

Laparoscopic gastrectomy for gastric cancer (i.e., total and distal gastrectomy accompanied with intensive regional lymph node dissection) is currently considered safe and feasible [1]. In Japan, based on definitive diagnoses according to the Japanese classification system [2], the Japanese guidelines [3] optimally indicate intentional dissection of regional lymph nodes as D1, D1+, D2, and D2+. Laparoscopic distal gastrectomy was first introduced in 1991 [4], and intracorporeal reconstruction has been adopted worldwide [5]. Laparoscopic total gastrectomy has developed relatively slowly because of technical difficulties [6], intracorporeal side-to-side reconstruction based on an antiperistaltic approach (“functional end-to-end anastomosis” [7]) or an isoperistaltic approach (“overlap anastomosis” [8]) is performed

Methods

Results

Conclusion