Laparoscopic Hunt-Lawrence Jejunal Pouch for Reconstruction After Total Gastrectomy for Gastric Cancer.

There are several reconstruction options described in the literature after total gastrectomy for gastric cancer. The most common laparoscopic jejunal pouch technique involves evisceration of the small bowel and extracorporeal pouch formation. We describe a completely intracorporeal technique for the Hunt-Lawrence J-pouch Roux-en-Y reconstruction. After gastrectomy and formation of the Roux limb, we create the esophagojejunal anastomosis using an end-to-end anastomosis (EEA) stapler threaded 6-7 cm into the Roux limb to leave a tail of jejunum for the pouch. Next we form the jejunal pouch with a linear stapler and close the common enterotomy with suture or stapler. Our technique offers a streamlined and efficient approach to the Hunt-Lawrence reconstruction and can be effectively performed both laparoscopically and robotically.