Laparoscopic Stomach-Partitioning Gastrojejunostomy with Reduced-Port Techniques for Unresectable Distal Gastric Cancer

Background: The improvement of quality of life is of great importance in managing patients with far-advanced gastric cancer. We report a new secure and less invasive method of creating a stomach-partitioning gastrojejunostomy in reduced-port laparoscopic surgery for unresectable gastric cancers with gastric outlet obstruction. Materials and Methods: A 2.5-cm vertical intraumbilical incision was made, and EZ Access (Hakko Co., Ltd., Tokyo, Japan) was placed. After pneumoperitoneum was created, an additional 5-mm trocar was inserted in the right upper abdomen. A gastrojejunostomy was performed in the form of an antiperistaltic side-to-side anastomosis, in which the jejunal loop was elevated in the antecolic route and anastomosed to the greater curvature of the stomach using an endoscopic linear stapler. The jejunal loop together with the stomach was dissected with additional linear staplers just proximal to the common entry hole so that a functional end-to-end gastrojejunostomy was completed. At the same time, the stomach was partitioned using a linear stapler to leave a 2-cm-wide lumen in the lesser curvature. Subsequently, jejunojejunostomy was performed 30 cm distal to the gastrojejunostomy, and the stomach-partitioning gastrojejunostomy resembling Roux-en Y anastomosis was completed. Results: All patients resumed oral intake on the day of operation. Neither anastomotic leakage nor anastomotic stricture was observed. Conclusions: Our less invasive palliative operation offers the utmost priority to improve quality of life for patients with unresectable gastric cancer.