Disturbed passage of jejunal limb near esophageal hiatus after overlapped esophagojejunostomy following laparoscopic total gastrectomy  

作　　者：Hirokazu Noshiro Keiichiro Okuyama Yukie Yoda 

机构地区：[1]Department of Surgery,Saga University Faculty of Medicine,Saga 849-8501,Japan [2]Department of Surgery,Saga University,Saga 849-8501,Japan

出　　处：《World Journal of Gastrointestinal Surgery》2022年第11期1285-1296,共12页世界胃肠外科杂志（英文版）（电子版）

基　　金：by the Institutional Review Board of Saga University Hospital(Approval No.2020-05-R-02).

摘　　要：BACKGROUND Overlapped esophagojejunostomy(OEJ) is a secure purely laparoscopic reconstruction after laparoscopic total gastrectomy(LTG). However, long-term surgical results have not been documented well.AIM 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.METHODS 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.RESULTS 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.CONCLUSION 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.

关 键 词：Laparoscopic total gastrectomy Overlapped esophagojejunostomy Anastomotic stenosis ADHESIOLYSIS Gastric carcinoma 

分 类 号：R656.61[医药卫生—外科学]