Short-term outcomes after totally laparoscopic total gastrectomy with esophagojejunostomy constructed by pi-shaped method versus overlap method

Background Regarding the overlap anastomosis and recently introduced pi-shaped anastomosis, there is no consensus on which intracorporeal esophagojejunostomy (EJS) methods are preferred using linear stapler in totally laparoscopic total gastrectomy (TLTG). This study aims to evaluate the short-term outcomes using two methods. Methods Patients with upper gastric cancer underwent TLTG with either pi-shaped (n = 48) or the modified overlap method using knotless barbed sutures (MOBS) (n = 37) were included in our study. Intraoperative and perioperative outcomes were compared. Results All patients achieved R0 resection margin. The overall esophagojejunal (E-J)-related complications rate was 7.06%. There was no significant difference between the two groups in terms of postoperative complications, margin distance, numbers of lymph nodes (LNs), length of stay. In the pi-shaped group, anastomosis time (19.61 +/- 7.17 min vs. 27.09 +/- 3.59 min, p < 0.001) was significantly lower. The consumable costs for surgery were similar (44 507.74 yen [42 933.03-46 937.29] vs. 43 718.36 yen [42 743.25-47 256.06], p = 0.825). The first defection time was significantly longer in pi-shaped group (131.00 h [93.75-171.25] vs. 100.00 h [85.00-120.00], p = 0.026), whereas the other postoperative recovery parameters were similar. No mortality was observed. Conclusions Both methods showed similar short-term postoperative outcomes. The pi-shaped technique was faster than the MOBS method without significantly increasing the supplies costs. Large prospective studies are warranted.