After endotracheal intubation and administering general anesthesia, a transverse incision measuring 3 to 3.5 centimeters was created around the navel to insert the SILS port equipped with four in-built trocars. An additional 12-millimeter trocar was inserted in the left upper quadrant to serve as an operative port for surgical instruments. The ultrasonic knife was used to dissect the adipose lymphoid tissue of groups 1, 2, 3, 4, 7, 8a, 9, and 11p.
A lower esophageal segment length of approximately 5 to 7 centimeters was ensured while maintaining the freedom of the greater and lesser curvatures of the stomach. The esophagus-jejunum or EJ anastomosis was identified on the jejunum, located 20 centimeters distal to the ligament of Treitz and near the lower esophagus. A 60-millimeter endoscopic linear stapler was used to create the EJ anastomosis through the 12-millimeter port in the left upper quadrant.
Next, a 60-millimeter endoscopic linear stapler was used to resect specimens of the esophagus and to close the anastomotic opening between the jejunum and esophagus. The gastrojejunal or GJ anastomosis was created with the site marked on the jejunum 8 to 15 centimeters distal to the EJ anastomosis and on the posterior wall of the greater curvature of the remaining stomach. Next, the jejunojejunal anastomosis was established using a 60-millimeter endoscopic linear stapler through the 3.5 centimeter incision at the navel, marking 5 centimeters distal to the GJ anastomosis site.
The individual anastomosis were closed and strengthened. Both the common openings of the GJ and jejunojejunal anastomosis were closed using a 3-0 micro Joe thread. Then, the mesangial hiatus was closed with a continuous suture.
At the end of the procedure, a drainage tube was placed behind the EJ anastomosis and exited through the left upper abdomen. The surgery was completed in 150 minutes with minimal interoperative bleeding of 5 milliliters and no complications reported postoperatively while 24 lymph nodes were retrieved with no metastasis detected. The patients recovery involved bed rest for two days.
The first flatus occurred at 70 hours postoperatively. And oral intake of liquid food began on the third day. The gastric tube was removed on day four, and the drainage tube was removed within seven days, showing efficient recovery milestones.
Upper gastrointestinal radiography revealed contrast agent retention in the remnant stomach for 30 to 50 minutes with no evidence of esophageal reflux. The cosmetic outcome of the postoperative abdominal incisions was satisfactory with minimal scarring evident.
