Abstract:

Objective

To compare the application effects of different esophagojejunal reconstruction methods in esophagojejunostomy during transhiatal laparoscopic total gastrectomy （TLTG） for gastric cancer patients.

Methods

The clinical data of 150 patients who underwent transhiatal laparoscopic total gastrectomy from June 2021 to June 2024 were retrospectively analyzed.According to different esophagojejunal reconstruction methods，they were divided into the reverse puncture group （n=75 cases） and the Overlap group （n=75 cases）.The reverse puncture group underwent esophagojejunal reconstruction using the reverse puncture method，and the Overlap group underwent esophagojejunal reconstruction using the Overlap method.The propensity score matching method was used to exclude confounding factors such as gender and age in the baseline data.The surgical situations of the two groups of patients （total operation time，intraoperative blood loss，anastomosis time，the distance from the upper margin of the tumor to the esophageal tangent line，length of hospital stay，hospitalization cost） and postoperative recovery situations （the time of the first out-of-bed activity after surgery，the time of the first anal exhaust after surgery，the length of postoperative hospital stay，the time of taking liquid diet after surgery），as well as the occurrence of postoperative complications were compared.

Results

There were no significant differences in the total operation time，intraoperative blood loss，the distance from the upper margin of the tumor to the esophageal tangent line，and the length of hospital stay between the two groups of patients （P＞0.05）.However，the anastomosis time and hospitalization cost in the reverse puncture group were significantly lower than those in the Overlap group （P＜0.05）.There were no significant differences in the postoperative recovery situations and the incidence of complications between the two groups of patients（P＞0.05）.

Conclusion

Both the reverse puncture method and the Overlap method are safe and reliable in esophagojejunostomy during TLTG for gastric cancer patients.However，the anastomosis time of the reverse puncture method is shorter，and the hospitalization cost for patients is lower.The appropriate surgical method can be selected according to the patient's condition.

Key words: Stomach Neoplasm, Total Gastrectomy, Laparoscopes, Reverse Puncture Method, Overlap Method