Purpose: The aim of this study was to compare end-to-side with side-to-side esophagojejunostomy after laparoscopy- assisted total gastrectomy (LATG) for gastric cancer in terms of complications.
Methods: One hundred and fourteen patients who underwent laparoscopy-assisted total gastrectomy for gastric cancer with curative intent from June 2003 to February 2010 at Seoul National University Bundang Hospital were retrospectively reviewed. Comparative analysis of short term outcomes including complications was performed to compare the end-to-side esophagojejunostomy (EJ) and side-to-side EJ groups.
Results: Overall morbidity and mortality rates after LATG were 17.5% (20 patients) and 0%, respectively. Comparing the end-to-side EJ group (93 patients) with the side-to-side EJ group (21 patients), there was no significant difference in operating time (242.3 versus 250.7 minutes), estimated blood loss (176.6 versus 133.3 ml), time to first flatus (3.8 versus 4.0 days), time to first soft diet (5.3 versus 5.7 days), postoperative morbidity (15.1% versus 28.6%), and mortality. However, there was a difference in postoperative hospital stay (9.0 versus 12.9 days, p=0.045). Also, the EJ leakage rate of the side-to side EJ group was higher than that of end-to-side EJ group (14.3%, 3 patients, versus 2.2%, 2 patients; p= 0.043).
Conclusion: End-to-side EJ can be recommended after LATG because the EJ leakage rate after end-to-side EJ was lower than that after side-to-side EJ.

Keywords: Laparoscopy-assisted total gastrectomy, Esophagojejunostomy, End-to-side, Side-to-side, Complication