A.A. Valiev1, A.R. Zubkova1, B.I. Gataullin2, I.G. Gataullin3, R.Sh. Khasanov3, B.R. Valitov1
1Republican Clinical Oncology Dispensary of Ministry of Healthcare of Tatarstan Republic named after prof. M.Z. Sigal, Kazan
2Kazan (Volga Region) Federal University, Institute of Fundamental Medicine and Biology, Kazan
3Kazan State Medical Academy ― Branch Campus of the FSBEI FPE RMACPE MOH Russia, Kazan
Gataullin Bulat I. ― Cand. of Sci. (Med.), Associate Professor of the Department of Surgery at the Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University
76 Karl Marx Str., Kazan, 420012, Russian Federation, tel. +7-962-553-31-07, e-mail: bulatg@list.ru, ORCID ID: 0000-0003-1695-168X
Abstarct. Currently, laparoscopic gastrectomy (LGE) for the treatment of gastric cancer (GC), remains challenging as there is still a high incidence of oesophagojejunoanastomosis suture failure, lack of uniform operating standards for laparoscopic reconstruction of the digestive tract, and advanced surgical techniques are required. This article displays technical aspects of the original technique of esophagojejunoanastomosis (EEA) formation in LGE.
The aim of the study was to develop a safer(reliable) and functional technique for esophagojejunoanastomosis in laparoscopic gastrectomy.
Material and methods. We have proposed an original method of esophagojejunoanastomosis formation at laparoscopic gastrectomy (patent: RU 2 806 015 C1 (12.12.2022)). One of the key objectives of the invention is to form a reliable and functional oesophagojejunoanastomosis by concealing the distal oesophagus and the mechanical sutures of the first row of the anastomosis in a serous-muscular case. From 2020 to 2023, we performed 25 surgical interventions using this technique in RR patients aged 51 to 81 years. No intraoperative complications were noted during the surgical interventions, the duration of the operations ranged from 180 to 250 minutes, the volume of blood loss during the surgical intervention from 50 to 150 ml.
Postoperative period. In the early postoperative period there was one failure of oesophageal-jejunal anastomosis sutures, which was resolved by conservative therapy and endoscopic installation of VAC-system (Vacuum-Assisted Closure). In the course of dynamic follow-up at the long-term follow-up, no cases of anastomosis stricture and esophageal reflux with the development of esophagitis were observed.
In this article the patented technique: «Method of esophagojejunoanastomosis during laparoscopic gastrectomy» is presented, a clinical case is given below.
Conclusion. We believe that the proposed technique will allow us to significantly reduce the incidence of EEA suture failure in LGE, achieve better functional results, and improve the clinical course of the disease and the quality of life of patients. However, it is necessary to continue clinical studies of this technique of anastomosis formation. Thus, new surgical technologies will improve the efficiency of surgical treatment of gastric cancer.
Key words: gastric cancer, laparoscopic gastrectomy, esophagojejunostomy, method of formation.