Application Value Of Modified π-shaped Esophagojejunostomy In Total Laparoscopic Total Gastrectomy

Objective:To investigate the safety and short-term efficacy of modified π-shaped esophagojejunostomy in total laparoscopic gastrectomy.Methods:Clinical data were collected from 67 patients with adenocarcinoma of the stomach body,fundus and cardia who underwent laparoscopic D2 radical total gastrectomy in the gastrointestinal tumor center of Cangzhou people’s hospital from January 2017 to November 2019.Among them,26 underwent totally laparoscopic modified π-shaped esophagojejunostomy and 41 underwent small-incision laparoscopic assisted end-to-side esophageal jejunostomy.By analyzing the two cases of the baseline data,incidence of complications(number of deaths,anastomotic fistula,anastomotic bleeding,anastomotic stenosis,abdominal cavity infection,surgical incision infection),conversion to open surgery,residual cancer cells on upper incised margin,operation time,intraoperative blood loss,length of incision,the time to first postoperative anal exhaust,the leaving bed time,the time of first feeding after operation,the time of gastric tube extraction after operation,the time of abdominal drainage tube extraction after operation,postoperative hospital stay,etc.,to discusses the safety and feasibility of the modified π-shaped esophagojejunostomy in total laparoscopic total gastrectomy.The purpose is to provide a better choice for clinical practice of digestive tract reconstruction.Results:There were no significant difference in gender,age,BMI and pathological characteristics(T stage,N stage,the number of cleared lymph nodes,the degree of differentiation of tumors,neural infiltration,vessel infiltration)between the two groups(P > 0.05).There were no perioperative deaths,no anastomotic fistula,no anastomotic bleeding,no anastomotic stenosis,no abdominal cavity infection,no surgical incision infection,no conversion to open surgery,no residual cancer cells on upper incised margin in the modified π-shaped esophagojejunostomy group.In the auxiliary small-incision group,1 patient died from bleeding,1 patient complicated with esophagojejunal anastomosis fistula and abdominal infection,1 case of incisive infection,1 case of conversion to open surgery,no anastomotic stenosis and no residual cancer cells on upper incised margin.The modifiedπ-shaped esophagojejunostomy group was significantly better than the auxiliary small-incision group in the operation time(208.7±33.7)min vs.(227.4±29.2)min,t=-2.415,P=0.019,amount of intraoperative blood loss(74.4±33.2)ml vs.(132.4±50.0)ml,t=-5.222,P<0.001,incision length(5.9±0.7)cm vs.(9.8±1.9)cm,t=-10.139,P<0.001,the time to first postoperative anal exhaust(2.8±0.7)d vs.(3.3±0.6)d,t=-2.897,P=0.005,the time of first leaving bed time after operation(2.3±0.6)d vs.(3.0±0.6)d,t=-4.529,P<0.001,the time of first feeding after operation(3.6±0.6)d vs.(4.1±0.6)d,t=-4.078,P<0.001,the time of gastric tube extraction after operation(5.2±0.6)d vs.(5.7±0.6)d,t=-3.940,P<0.001,the time of abdominal drainage tube extraction after operation(9.3±1.9)d vs.(13.3±3.4)d,t=-5.409,P<0.001 and the postoperative hospital stay(14.0±2.0)d vs.(17.7±3.7)d,t=-4.731,P<0.001.Conclusion:Totally laparoscopic modified π-shaped esophagojejunostomy is safe and feasible,with less trauma and faster postoperative recovery compared with traditional small-incision laparoscopic assisted end-to-side esophageal jejunostomy.