Re-do laparoscopic esophagojejunostomy for anastomotic stenosis after laparoscopic total gastrectomy in gastric cancer

Langenbecks Arch Surg. 2022 Nov;407(7):3133-3139. doi: 10.1007/s00423-022-02632-3. Epub 2022 Aug 18.

Abstract

Purpose: Anastomotic stenosis of esophagojejunostomy after total gastrectomy has a substantial impact on the postoperative quality of life of the patient. If conservative treatment doesn't work, surgical intervention should be considered. However, redoing esophagojejunostomy is an extremely demanding procedure. Especially in the case where the primary surgery was performed laparoscopically, it is an unmet problem to maintain minimal invasiveness in re-do surgery.

Methods: We report 3 cases of re-do esophagojejunostomy laparoscopically performed for anastomotic stenosis after laparoscopic total gastrectomy in gastric cancer, in whom endoscopic balloon dilation did not work.

Results: Each patient underwent a re-do esophagojejunostomy laparoscopically. The mean operation time was 293 min, and the mean blood loss was 56 ml. There was no anastomosis-related complication, and they were discharged from hospital on 11-16 postoperative days. At the time of discharge, oral food intake was 100% in each patient. One year after the operation, follow-up endoscopic exams showed no anastomotic stenosis.

Conclusion: Re-do laparoscopic esophagojejunostomy for anastomotic stenosis after laparoscopic total gastrectomy was safely and successfully performed. It brings patients minimal invasiveness continuously from the initial surgery. Re-do laparoscopic esophagojejunostomy could be one of the options for anastomotic stenosis resistant to conservative treatment.

Keywords: Anastomosis; Esophagojejunostomy; Gastric cancer; Laparoscopic total gastrectomy; Re-do; Stenosis.

MeSH terms

  • Anastomosis, Surgical / adverse effects
  • Anastomosis, Surgical / methods
  • Constriction, Pathologic / etiology
  • Constriction, Pathologic / surgery
  • Gastrectomy / adverse effects
  • Gastrectomy / methods
  • Humans
  • Jejunostomy / methods
  • Laparoscopy* / adverse effects
  • Laparoscopy* / methods
  • Quality of Life
  • Retrospective Studies
  • Stomach Neoplasms* / complications
  • Stomach Neoplasms* / surgery