Hand-sewn Esophagojejunostomy In Laparoscopic Total Gastrectomy

Objective We designed the research to evaluate the safety and practicability of laparoscopic total gastrectomy with hand-sewn esophagojejunostomy.Our purpose is to provide credible support for clinical application of the anastomotic method.Methods We consulted and collected the information of the patients who had received laparoscopic total gastrectomy between October 2019 and October 2021 in our hospital.We reviewed and studied the information,and divided the patients into the hand-sewn group and the circular stapler group according to methods of esophagojejunostomy.First,we comparatively analyzed the general information that covering the gender,the age,the BMI,the diameter of tumor,the location of tumor,the TNM stage,and the ASA grade between the two groups.Then,we used the propensity score matching method to screen the two groups.Finally,we comparatively analyzed the intraoperative condition,the postoperative condition,the incidence and the severity of the postoperative complications between the two groups.Results We incorporated 112 patients in the study according to the inclusion and the exclusion criteria.The hand-sewn group had 60 patients.The circular stapler group had52 patients.There were no remarkable divergences in the gender,the age,the diameter of tumor,the location of tumor,the ASA grade between the two groups(P>0.05).The divergences in the BMI,the TNM stage between the two groups were statistically remarkable(P<0.05).There had 45 patients who were successfully matched by the propensity score matching method.There were no remarkable divergences in the general information between the two groups(P>0.05).There were no remarkable divergences in the postoperative hospital stay,the anal exhaust time,the intraoperative blood loss between the two groups(P>0.05).Compared with the circular stapler group,the hand-sewn group had shorter operative time,shorter anastomotic time,shorter incision,milder pain,lower cost of hospitalization,and the divergences were statistically remarkable(P<0.05).There were no remarkable divergences in the incidence and the severity of postoperative complications between the two groups(P>0.05).In the hand-sewn group,the incidence of esophagojejunal anastomotic complication was 4.4%,incidences of both esophagojejunal anastomotic leak and esophagojejunal anastomotic stenosis were 2.2%.In the circular stapler group,the incidence of esophagojejunal anastomotic complication was 11.1%,incidences of both esophagojejunal anastomotic leak and esophagojejunal anastomotic stenosis were4.4%,the incidence of esophagojejunal anastomotic bleeding was 2.2%.Conclusions It is safe and practicable to reconstruct esophagojejunal continuity by hand-sewn anastomosis in laparoscopic total gastrectomy.Patients who has high locational tumour,obesity and small costal angle can get more minimally invasive benefit and save medical costs.It is advised to develop the anastomotic method in hospitals with advanced laparoscopic technology.