Esophagogastric tube reconstruction with stapled pseudo-fornix in laparoscopic proximal gastrectomy: a novel technique proposed for Siewert type II tumors

Hosogi, Hisahiro; Yoshimura, Fumihiro; Yamaura, Tadayoshi; Satoh, Seiji; Uyama, Ichiro; Kanaya, Seiichiro
April 2014
Langenbeck's Archives of Surgery;Apr2014, Vol. 399 Issue 4, p517
Academic Journal
Purpose: The incidence of adenocarcinoma of the esophagogastric junction is increasing, but laparoscopic proximal gastrectomy is not widely accepted due to the absence of a standardized technique of reconstruction. This report describes a novel technique of esophagogastric tube reconstruction in laparoscopic proximal gastrectomy for Siewert type II tumors. Methods: Laparoscopic proximal gastrectomy, sometimes with transhiatal distal esophagectomy, was performed. After a perigastric, suprapancreatic, and lower thoracic paraesophageal lymphadenectomy, a gastric tube of 35-mm width was prepared. An esophagogastric tube anastomosis with pseudo-fornix was made with a no-knife linear stapler to prevent postoperative reflux esophagitis. Results: Fifteen patients with Siewert type II tumors underwent this operation. They included six patients with early-stage cancer, six at high risk for transhiatal total gastrectomy due to several comorbidities, and three who needed palliative tumor resection. The mean operation time was 315 min. One postoperative anastomotic leak was treated conservatively, and three anastomotic stenoses were resolved with endoscopic balloon dilatation. Postoperative 1-year follow-up endoscopy revealed four cases of reflux esophagitis that were well controlled by medication. Conclusions: This new technique of reconstruction was feasible. With the advantage of a gastric tube, a tension-free anastomosis was possible even for bulky tumors that needed lower esophagectomy. Although long-term follow-up and a larger number of patients are required to evaluate long-term functional outcomes and oncological adequacy, our procedure has the potential of becoming a treatment of choice for early-stage Siewert type II tumors and/or for some selected high-risk patients who need tumor resection.


Related Articles

  • Managing gastro-oesphageal refl ux disease the surgical way. Van Baalen, Cathy // Gastrointestinal Nursing;Mar2008, Vol. 6 Issue 2, p24 

    The global prevalence of gastro-oesophageal reflux disease (GORD) is between 5-20%, with the highest incidence found in Europe and the USA. Its negative effect upon quality of life, mental health and social function are often underestimated. The mainstay of treatment in recent years has been...

  • Laparoscopic Devascularization of the Lower Esophagus and Upper Stomach:Experimental Study in the Pig. Salama, Ibrahim Abdelkader; Helmy, AMR; Connolly, Raymond; Schwaitzberg, Steven D. // Journal of Laparoendoscopic & Advanced Surgical Techniques;Feb2003, Vol. 13 Issue 1, p59 

    Background: Esophagogastric devascularization is an alternative treatment for bleeding gastroesophageal varices. The aim of this experimental study was to develop an approach for laparoscopic devascularization of the lower esophagus and upper stomach. Materials and Methods: We used six swine...

  • Laparoscopic Surgery for Submucosal Tumor Near the Esophagogastric Junction. Kim, Hee Sung; Kim, Min Gyu; Kim, Beom Su; Lee, In Seob; Lee, Sol; Yook, Jeoung Hwan; Kim, Byung Sik // Journal of Laparoendoscopic & Advanced Surgical Techniques;Mar2013, Vol. 23 Issue 3, p225 

    Background: Laparoscopic surgery is widely accepted as a treatment for gastric submucosal tumors (SMTs). However, laparoscopy is not easily applied to tumors near the esophagogastric junction (EGJ). This study was conducted to evaluate laparoscopic techniques for treating SMTs near the EGJ....

  • Transoral Extraction of a Laparoscopically Resected Large Gastric GIST. Huscher, Cristiano G.S.; Mingoli, Andrea; Sgarzini, Giovanna; Mogini, Valerio // Journal of Laparoendoscopic & Advanced Surgical Techniques;Aug2013, Vol. 23 Issue 8, p707 

    Although natural orifice specimen extraction is now widely performed, there have been no reports of transoral extraction following laparoscopic gastric resection. This report describes the first transoral specimen extraction in a patient with a gastrointestinal stromal tumor (GIST) of the lesser...

  • Significant pressure differences between solid-state and water-perfused systems in lower esophageal sphincter measurement. Gehwolf, Philipp; Hinder, Ronald; DeVault, Kenneth; Edlinger, Michael; Wykypiel, Heinz; Klingler, Paul; Hinder, Ronald A; DeVault, Kenneth R; Wykypiel, Heinz F; Klingler, Paul J // Surgical Endoscopy;Dec2015, Vol. 29 Issue 12, p3565 

    Objective: High-resolution manometry of the esophagus has gained worldwide acceptance, using different solid-state catheters. Thus, normal values for lower esophageal sphincter (LES) resting pressure in suspected gastroesophageal reflux disease patients have been established using...

  • Sleeve Gastrectomy and Development of 'De Novo' Gastroesophageal Reflux. Genio, Gianmattia; Tolone, Salvatore; Limongelli, Paolo; Brusciano, Luigi; D'Alessandro, Antonio; Docimo, Giovanni; Rossetti, Gianluca; Silecchia, Gianfranco; Iannelli, Antonio; Genio, Alberto; Genio, Federica; Docimo, Ludovico // Obesity Surgery;Jan2014, Vol. 24 Issue 1, p71 

    Background: Sleeve gastrectomy (SG) is currently gaining popularity due to an excellent efficacy combined to minimal anatomic changes. However, some concerns have been raised on increased risk of postoperative gastroesophageal reflux disease (GERD) due to gastric fundus removal, section of the...

  • Outcome of Laparoscopic Antireflux Surgery in Patients With Nonerosive Reflux Disease Bammer, Tanja; Freeman, Mark; Shahriari, Ali; Hinder, Ronald A.; DeVault, Kenneth R.; Achem, Sami R. // Journal of Gastrointestinal Surgery;Sep2002, Vol. 6 Issue 5, p730 

    As many as 50% of patients with gastroesophageal reflux disease (GERD) have no endoscopic evidence of esophagitis (EGD negative). Laparoscopic antireflux surgery (LARS) provides effective symptomatic and endoscopic healing in patients with erosive GERD (EGD positive). The surgical outcome of...

  • Laparoscopic Antireflux Surgery With Routine Mesh-Hiatoplasty in the Treatment of Gastroesophageal Reflux Disease Granderath, Frank A.; Schweiger, Ursula M.; Kamolz, Thomas; Pasiut, Martin; Haas, Christoph F.; Pointner, Rudolph // Journal of Gastrointestinal Surgery;May2002, Vol. 6 Issue 3, p347 

    One of the most frequent complications after laparoscopic antireflux surgery is intrathoracic migration of the wrap (“slipped” Nissen fundoplication). The most common reasons for this are inadequate closure of the crura or disruption of the crural closure. The aim of this prospective...

  • A poor response to proton pump inhibition is not a contraindication for laparoscopic antireflux surgery for gastro esophageal reflux disease. Wilkerson, P. M.; Stratford, J.; Jones, L.; Sohanpal, J.; Booth, M. I.; Dehn, T. C. B. // Surgical Endoscopy;Sep2005, Vol. 19 Issue 9, p1272 

    Background: We aimed to determine if a poor response to proton pump inhibitors (PPIs) can predict a poor outcome following laparoscopic antireflux surgery (LARS) in our surgically treated population.Methods: A total of 324 patients undergoing LARS were included in this...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics