Feasibility and Short-Term Outcomes of Three-Dimensional Hand-Sewn Esophago-Jejunal Anastomosis in Completely Laparoscopic Total Gastrectomy for Cancer

SIMPLE SUMMARY: Laparoscopic total gastrectomy for the treatment of gastric and esophago-gastric junction cancer is on the rise. The procedure’s rate-limiting step is the construction of the esophago-jejunal anastomosis. Most surgeons are performing the anastomosis laparoscopically by utilizing an endoscopic linear or circular stapler; scarce evidence exists regarding laparoscopic hand-sewn esophago-jejunal anastomosis. Herein, we present our technique and results of laparoscopic manual esophago-jejunal anastomosis during totally laparoscopic total gastrectomy for gastric and esophago-gastric junction cancer. Anastomosis was performed in a two-layer fashion. Overall implementation provided excellent surgical outcomes in our cohort of patients; median anastomotic time was 55 min, while median operating time was 240 min. Intra-operative methylene blue leak test was negative in all cases. No anastomotic leak or anastomotic stricture were noted postoperatively. The 30-day and 90-day mortality rates were zero. ABSTRACT: Laparoscopic total gastrectomy is on the rise. One of the most technically demanding steps of the approach is the construction of esophago-jejunal anastomosis. Several laparoscopic anastomotic techniques have been described, like linear stapler side-to-side or circular stapler end-to-side anastomosis; limited data exist regarding hand-sewn esophago-jejunal anastomosis. The study took place between January 2018 and June 2021. Patients enrolled in this study were adults with proximal gastric or esophago-gastric junction Siewert type III tumors that underwent 3D-assisted laparoscopic total gastrectomy. A hand-sewn esophago-jejunal anastomosis was performed in all cases laparoscopically. Forty consecutive cases were performed during the study period. Median anastomotic suturing time was 55 min, with intra-operative methylene blue leak test being negative in all cases. Median operating time was 240 min, and there were no conversions to open. The anastomotic leak rate and postoperative stricture rate were zero. The 30- and 90-day mortality rates were zero. Laparoscopic manual esophago-jejunal anastomosis utilizing a 3D platform in total gastrectomy for cancer can be performed with excellent outcomes regarding anastomotic leak and stricture rate. This anastomotic approach, although technically challenging, is safe and reproducible, with prominent results that can be disseminated in the surgical community.