A modified overlap method using a linear stapler for intracorporeal esophagojejunostomy after laparoscopic total gastrectomy.

Objective: Intracorporeal esophagojejunostomy represents the most difficult step during laparoscopic total gastrectomy (LTG). A novel technique for intracorporeal esophagojejunostomy was recently developed and named the "overlap method." However, this procedure is thought to have some technical disadvantages. To facilitate intracorporeal esophagojejunostomy, we developed some modifications for the overlap method.

Methods: From October 2009 to July 2013, 63 consecutive patients with gastric cancer underwent LTG at our institution. Our modified overlap method was used for 54 patients with the following modifications. First, the esophagus was transected while being rotated by approximately 90 degrees in the clockwise direction. Second, an endoscopic linear stapler was used through the right lower trocar to create a side-to-side esophagojejunostomy. Third, the entry hole of the linear stapler was closed with intracorporeal hand-sewn continuous suturing. This procedure was termed the "modified overlap method."

Results: In 53 patients with the exception of one case, the modified overlap method was successfully completed (98.1%). Only one patient developed esophagojejunal anastomotic leakage (1.9%), which recovered well with conservative management. No postoperative anastomotic stricture or bleeding occurred.

Conclusions: Our modified overlap method for intracorporeal esophagojejunostomy provides amazingly satisfactory outcomes. We believe this procedure could become a standard method for intracorporeal esophagojejunostomy after LTG.