Feasibility and safety of a novel reverse puncture device (RPD) for laparoscopic esophagogastrostomy/esophagojejunostomy.

backgroundWe aimed to report the feasibility and safety of the technique after laparoscopy-assisted total gastrectomy (LATG) or laparoscopy-assisted proximal gastrectomy (LAPG): intracorporeal circular stapling esophagogastrostomy/esophagojejunostomy using the reverse puncture device (RPD).

methodsLaparoscopy-assisted esophagogastrostomy/esophagojejunostomy was performed in 14 gastric cancer cases and 4 cases of cardiac stromal tumors using a newly developed RPD to place the anvil. After LATG or LAPG, an approximately 2 cm transverse incision was made at the esophagus anterior wall at 2 cm above the cardia and the RPD was then introduced via the incision. The end of the RPD was sutured out "reversely" at 3 cm above the esophagotomy incision. Double-stapling esophagogastrostomy/esophagojejunostomy with a circular stapler was then performed under laparoscopic assistance.

resultsThere was no intraoperative complication or conversion to open surgery, the mean operation time was 155 min, the mean anvil placement time was 12 min, and the mean blood loss was 75 mL. Patients resumed oral liquid diet on postoperative day 2, and discharged at day 10. There was no mortality, no anastomotic leakage, anastomotic stenosis, intra-abdominal infections or other complications. No recurrence was found during the 11 to 25 month follow up. Postoperative gastrointestinal iodine solution radiography revealed no anastomosis leakage or stenosis.

conclusionsWe have successfully performed LATG or LAPG reconstruction using our technique in 18 patients without any complications. We believe that our procedure is a secure and reliable reconstruction method, and is especially useful in obese patients, in whom conventional manipulations are often difficult.