Noshiro Hirokazu, Okuyama Keiichiro, Yoda Yukie
Department of Surgery, Saga University Faculty of Medicine, Saga 849-8501, Japan.
Department of Surgery, Saga University, Saga 849-8501, Japan.
World J Gastrointest Surg. 2022 Nov 27;14(11):1285-1296. doi: 10.4240/wjgs.v14.i11.1285.
Overlapped esophagojejunostomy (OEJ) is a secure purely laparoscopic reconstruction after laparoscopic total gastrectomy (LTG). However, long-term surgical results have not been documented well.
In this paper, we report unusual patients who manifested jejunal limb stricture near the esophageal hiatus without anastomotic stenosis during long-term observation after surgery.
From April 2009 until May 2020, we retrospectively reviewed 211 patients underwent LTG following by OEJ for gastric carcinoma and took a standard surveillance program. We aimed to characterize a novel complicated disorder observed in these patients to assist treatment and prevention.
Five patients (2.4%) had unusual jejunal limb stricture after LTG and OEJ, occurring at a mean of 10 mo after initial radical LTG. All five patients had disturbed oral intake and marked weight loss, and two had aspiration pneumonia. Various diagnostic modalities and intraoperative findings in each patient revealed an intact anastomosis, bent or tortuous jejunal limb resulting from loose fibrous adhesions on the left crus at the esophageal hiatus and no cancer recurrence. All five patients were successfully treated by reoperation for adhesiolysis, division of the left crus and rearrangement of the jejunal limb.
Disturbed passage through the jejunal limb near the hiatus can occur after some types of OEJ following LTG. We speculate that it may result from a short remnant esophagus, excessive mobilization of the jejunal limb that permits bending or tortuosity and adhesions on the left crus at the hiatus. Prevention for this complication is possible during the original LTG procedure.
重叠式食管空肠吻合术（OEJ）是腹腔镜全胃切除术（LTG）后一种安全的纯腹腔镜重建术。然而，长期手术结果尚未得到充分记录。
在本文中，我们报告了一些特殊患者，他们在手术后的长期观察中出现了食管裂孔附近空肠袢狭窄，但无吻合口狭窄。
从2009年4月至2020年5月，我们回顾性分析了211例行LTG并随后行OEJ治疗胃癌的患者，并采用了标准的监测方案。我们旨在描述在这些患者中观察到的一种新型复杂疾病，以辅助治疗和预防。
5例患者（2.4%）在LTG和OEJ术后出现了异常的空肠袢狭窄，平均发生在初次根治性LTG术后10个月。所有5例患者均有经口摄入障碍和明显体重减轻，2例有吸入性肺炎。各患者的各种诊断方法和术中发现显示吻合口完整，食管裂孔处左膈脚的疏松纤维粘连导致空肠袢弯曲或扭曲，且无癌症复发。所有5例患者均通过再次手术行粘连松解、左膈脚分离和空肠袢重新排列而成功治疗。
LTG术后某些类型的OEJ可能会出现食管裂孔附近空肠袢通过障碍。我们推测这可能是由于食管残端短、空肠袢过度游离导致弯曲或扭曲以及裂孔处左膈脚粘连所致。在原LTG手术过程中有可能预防这种并发症。
