Reconstruction of esophagojejunostomies using endoscopic linear staplers in totally laparoscopic total gastrectomy: report of 139 cases in a large-volume center.

Totally laparoscopic total gastrectomy for gastric cancer is not a commonly performed procedure due to the technical difficulty. We devised a technique for intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. In the reconstruction, nearly two thirds of the diameter of the esophagus was transected with an endoscopic linear stapler and the unstapled esophagus was transected with laparoscopic scissors. First suture was created at the end of the stapled line and second suture was created at the esophagostomy. During the reconstruction, assistants retracted the 2 sutures to prevent slippage of the esophageal stump into the thoracic cavity. Finally the remnant entry hole was closed with an endoscopic linear stapler. This reconstruction was successfully performed in all patients; none of the patients required conversion to open surgery. All operations were curative and there were no deaths. This method can be performed easily and safely, and may become a powerful alternative procedure for totally laparoscopic total gastrectomy.