Expectations and challenges of laparoscopic total gastrectomy

Relationship between mode of esophagojejunostomy in laparoscopic radical total gastrectomy and complications

AIM: To analyze the relationship between mode of esophagojejunostomy in laparoscopic radical total gastrectomy and complications.

METHODS: The clinical data for 89 patients who underwent Roux-en-Y anastomosis and 81 patients who underwent Lahey-Braun anastomosis in laparoscopic radical total gastrectomy at our hospital from January 2011 to January 2014 were analyzed retrospectively. Total operative time, blood loss, time to postoperative anal exhaust, time to recovery of food intake, overall complication rate, and rates of reflux esophagitis, anastomotic bleeding and anastomotic fistula were compared between the Roux-en-Y group and the Lahey-Braun group.

RESULTS: Laparoscopic radical total gastrectomy was successful in all the 170 patients. Blood loss was significantly less in the Roux-en-Y group than in the Lahey-Braun group (120.8 mL ± 21.3 mL vs 131.1 mL ± 16.4 mL, P < 0.05). Time to postoperative anal exhaust was statistically shorter in the Roux-en-Y group than in the Lahey-Braun group (2.1 d ± 1.3 dvs 2.6 d ± 1.4 d, P < 0.05). Total complication rate was statistically lower in the Roux-en-Y group than in the Lahey-Braun group (34.6% vs 59.6%, P < 0.01). Incidence of reflux esophagitis was statistically lower in the Roux-en-Y group than in the Lahey-Braun group (22.2% vs 52.8%, P < 0.01). There were no significant differences in other indicators between the two groups.

CONCLUSION: The efficacy and safety of Lahey-Braun anastomosis and Roux-en-Y anastomosis in laparoscopic radical total gastrectomy are basically same. However, the incidence of reflux esophagitis in Roux-en-Y anastomosis is significantly lower than that in Lahey-Braun anastomosis.