Abstract:
Objective
To investigate the application effects of two modified esophagojejunostomy methods，namely the modified reverse puncture and the modified overlap，in laparoscopic total gastrectomy.
Methods
A prospective study was conducted on 82 patients with Siewert type Ⅱ or Ⅲadenocarcinoma of the esophagogastric junction（AEG）from January 2021 to April 2023.All patients underwent laparoscopic total gastrectomy（TLTG）and were randomly divided into two groups（41 cases in each group）using the random number table method.The overlap anastomosis group received the modified esophagojejunal overlap anastomosis，while the reverse puncture anastomosis group underwent the modified reverse puncture esophagojejunostomy.Measurement data（such as anastomosis time and quality-of-life scores）were expressed as（![]()
），and an independent-samples t test was performed between groups.The incidence of complications was expressed as a percentage，and a chi-square test was performed between groups.
Results
The operations in both groups were successfully completed without any cases converted to open surgery，and all patients received RO resection.There were no statistically significant differences between the two groups in terms of intraoperative blood loss，total number of lymph node dissections，time to flatus，time to start eating，and length of hospital stay（P﹥0.05）.The anastomosis time，operation time，and the distance between the esophageal resection margin and the upper edge of the tumor were all longer in the reverse puncture anastomosis group than in the overlap anastomosis group（P﹤0.05）.There was no statistically significant difference in the total incidence of complications between the two groups（9.8%vs.14.6%，P﹥0.05）.There were no statistically significant differences in the QLQ-C30 and QLQ-STOR22 scores between the two groups before surgery，6 months after surgery，and 12 months after surgery（P﹥0.05）.
Conclusion
In the treatment of Siewert typeⅡ or Ⅲ AEG with TLTG，the modified overlap anastomosis method is easy to operate and helps to shorten the operation time.In contrast，the modified reverse puncture anastomosis method can provide a higher upper esophageal resection margin，significantly reducing the risk of positive upper resection margins caused by the high position of the esophagus in Siewert type Ⅱ AEG.
Key words:
Stomach Neoplasms,
Laparoscopic Total Gastrectomy,
Esophagojejunal Anastomosis,
Improved Overlap,
Improved Reverse Puncture Method
Haoyu Wang, Shuanyuan Yang, Yanshun Ren, Zhiqiang Yin. Clinical comparative study of two modified esophagojejunostomies in laparoscopic total gastrectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(04): 425-428.