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  • Title: Creation of a Jejunal Pouch During Laparoscopic Total Gastrectomy and Roux-en-Y Esophagojejunostomy.
    Author: Ward MA, Ujiki MB.
    Journal: Ann Surg Oncol; 2017 Jan; 24(1):184-186. PubMed ID: 27581611.
    Abstract:
    BACKGROUND: The creation of Hunt-Lawrence jejunal pouches after total gastrectomy is associated with a better quality of life compared with the standard Roux-en-Y esophagojejunostomy. To the authors' knowledge, this is the first video to show the technical aspects of creating a jejunal pouch during a laparoscopic total gastrectomy. METHODS: A 35-year-old woman was seen for surgical evaluation of a newly diagnosed CDH1 gene mutation. The authors recommended a laparoscopic total gastrectomy with Hunt-Lawrence pouch reconstruction. The jejunal pouch was created using an extracorporeal approach after removal of the stomach. A laparoscopic gel port was then placed over the extraction site to maintain pneumoperitoneum to facilitate a laparoscopic esophagojejunal pouch anastomosis using a circular stapler. RESULTS: The patient was discharged home on postoperative day 4. Her pathology showed no gastric cancer, and all 31 lymph nodes harvested were free of malignancy. At 1 year postoperatively, she had lost 25 lb from her presurgerical weight and was maintaining a healthy body mass index of 24 kg/m2. CONCLUSION: Hunt-Lawerence jejunal pouches have been shown to improve quality of life compared with esophagojejunostomy without pouch formation after total gastrectomy. This video shows a novel technique for jejunal pouch creation during laparoscopic total gastrectomy using a laparoscopic gel port after gastric extraction to facilitate a laparoscopic esophagojejunal pouch anastomosis.
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