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

• After gastrectomy Roux-en-Y esophagojejunostomy is a technically rather straightforward standard procedure with favorable long-term functional results. It requires sufficient length (50-60cm) of the interposed jejunal segment. Staplers are useful here because their insertion does not require any additional incisions in the bowel.

• The surgeon must have mastered the technique of hand sewn anastomoses before turning to staplers. Another prerequisite is precise handling of the staplers: Their technology must be practiced, and their dangers as well as sources of error must be known.

• Is included in the work-up of the underlying disease.

• If necessary, initiate nutritional support before surgery in patients with marked preoperative weight loss.
• Otherwise, no special regimen regarding laxative measures is needed.
• As routinely required by the anesthesiologists, the patient should have nothing by mouth before surgery (at least 2 - 6 hours).

• Failure of the esophagojejunostomy
• Failure of the jejunojejunostomy
• Changes in the postoperative diet requiring several (5 - 6) small meals during the day.
• Vitamin B12 substitution at least every 3 months
• Weight loss after gastrectomy, which probably will rise to about 10% of body weight.

General risks, e.g., postoperative bleeding, thrombosis, embolism, infectious complications such as wound/intraabdominal abscess.