Perioperative management - Gastrointestinal anastomosis technique, Roux-en-Y esophagojejunostomy

After gastrectomy , esophagojejunostomy with Roux-en-Y anastomosis is a technically relatively simple standard procedure with favorable functional long-term results. The prerequisite for this is that the interposed jejunal segment is sufficiently long (50-60 cm). The use of a stapling device is advisable, as no additional openings of intestinal organs need to be made for inserting the device.

A prerequisite for the use of staple suturing devices is mastery of hand suturing. Also required is precise handling of the suturing machines; their technique must be practiced, and dangers and sources of error must be known.

Is performed in the context of the present underlying disease.

If necessary, initiate preoperative nutritional therapy in patients who have lost significant weight preoperatively.
Otherwise, no special therapy regarding laxative measures is required. The patient should only be kept fasting preoperatively in a standard manner, as required by anesthesiology (minimum 2 – 6 h).

• Insufficiency of the esophagojejunostomy
• Insufficiency of the enteroenterostomy
• Altered postoperative nutrition requiring several small meals (5 – 6 distributed throughout the day)
• Vitamin B12 substitution at least every 3 months
• Weight loss after gastrectomy, which will amount to approx. 10% of body weight.

General risks such as postoperative bleeding, thrombosis, embolism, infectious complications in the sense of wound abscess or intra-abdominal abscess.