Application of modified π-shaped anastomosis in digestive tract reconstruction during totally laparoscopic total gastrectomy: a feasibility study.

OBJECTIVE

To investigate the feasibility and short-term efficacy of the modified π-shaped anastomosis technique for esophagogastric anastomosis in gastrointestinal reconstruction after total gastrectomy performed entirely by laparoscopy.

METHODS

This study included 50 patients who underwent totally laparoscopic gastrectomy with modified π-shaped anastomosis for gastrointestinal reconstruction at the First Affiliated Hospital of Wannan Medical College from August 2021 to August 2023. In this study, intraoperative and postoperative indicators were measured to assess the feasibility and short-term efficacy of this technique. Our modified surgical approach involved first resecting the jejunal mesentery and dividing the jejunum during gastrointestinal tract reconstruction, followed by esophagojejunal anastomosis.

RESULTS

The surgery was successfully completed for all 50 patients. The operation time was 251.3 ± 43.2 min, the postoperative hospital stay was 9.3 ± 1.3 days, the time to first postoperative ventilation from the end of the surgery was 4.3 ± 1.9 days, and the time to first postoperative feeding was 7.8 ± 1.6. No complications such as intestinal obstruction, anastomotic fistula, or anastomotic stenosis were observed. One patient developed anastomotic bleeding, one patient experienced an incisional infection, and two patients had pleural effusions. All 50 patients were followed up for more than one year, with no evidence of long-term complications or recurrence.

CONCLUSION

Modified π-shaped anastomosis is effective for digestive tract reconstruction during totally laparoscopic total gastrectomy (TLTG), thereby effectively preventing mucosal eversion, reducing anastomotic tension, and decreasing the incidence of anastomotic leakage.