Lymphnode dissection and esophageal anastomosis are considered the more demanding steps of laparoscopic gastrectomy for cancer. We report a laparoscopic total gastrectomy and D2 lymphadenectomy performed with a circular mechanical end-to-side esojejunostomy.

A 51 year old female consulted for degenerate gastric ulcer without other symptoms or history. Preoperative work-up showed a voluminous ulcer of 3 cm at the incisura angularis of the stomach with irregular margins and no satellite lymphnodes. Biopsy confirmed a poorly differentiated adenocarcinoma. Five trocars were placed in the abdomen. D2 lymphadenectomy started with the dissection of the anterior peritoneal sheet at the level of the pancreatic head. The pylorus was sectioned by a firing of linear stapler blue load using Seamguard. Abdominal esophagus was partially sectioned by scissors, and after introducing a 25 mm circular anvil, it was completely cut and tied by a purse string stitch. The procedure ended with the manufacturing of the side-to-side jejunojejunostomy at 60 cm from the esojejunostomy, and closure of the mesenteric and Petersen defects. The specimen was retrieved by a suvrapubic incision and a drain was left in the cavity.

Total operative time was 330 min and the estimated blood loss was 200 ml. The patient was discharged on the 7th p.o. day. Pathology confirmed the undifferentiated adenocarcinoma; final TNM stage: T1N0M0.

Thanks to laparoscopy, besides the advantages of rapid recovery of bowel function, short hospitalization, better cosmesis, a meticulous lymphadenectomy can be performed under excellent view. Anvil of the circular stapler can easily be introduced in the esophagus transabdominally.