Objective To explore feasibility and safety of π-shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy (TLTG).Method The clinical data of 20 patients who underwent TLTG, admitted in the Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2018 were retrospectively analyzed.Results TLTG with π-shaped esophagojejunal anastomosis was successfully carried out in all 20 patients. The operative time was (236.0±55.5) min, the π-shaped esophagojejunal anastomosis time was (25.7±4.8) min, the intraoperative blood loss was (192.0±148.9) mL, the operative incision length was (3.7±0.8) cm. The postoperative pain score was 2.4±1.1, the first flatus time was (3.1±0.9) d, the first postoperative ambulation time was (1.8±0.7) d, the removal time of nasoenteral nutrution tube was (7.4±2.4) d, the liquid diet time was (6.2±1.4) d, the removal time of intraoabdominal drainage tube was (7.8±2.8) d, the postoperative hospital stay was (10.8±3.0) d. There was no death related to the anastomosis in all patients. Two patients developed a little pleural effusion and 1 patient developed lymphatic leakage were cured with conservative treatment. One patient with intraabdominal encapsulated effusion was cured by puncture and drainage treating. There was no postive incisal margin. The length of upper segment of resection form gastric cancer was (2.3±1.7) cm, the maximum tumor diameter was (4.9±2.8) cm, the number of dissected lymph nodes was 27.9±5.6. All patients were followed up 3–15 months. Eight patients underwent endoscopic examination had no obvious anastomosis stenosis and esophageal reflux. Two patients died of tumor recurrence and metastasis witnin one year after operation, and the rest had disease-free survival until the end of follow-up.Conclusion From preliminary results of limited cases in this study, π-shaped esophagojejunal anastomosis in TLTG is a technically safe and feasible surgical procedure in treatment of gastric cancer.
GONG Shuai, ZHANG Pengbo, ZHANG Chong, WU Nai, ZHANG Yi, MA Yudong, DU Mingnan, REN Zeqiang, ZHANG Xiuzhong. Application of π-shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(9): 1188-1192. doi: 10.7507/1007-9424.202012049