Comparison of hand-sewn anastomosis and FETE anastomosis in totally laparoscopic total gastrectomy among elderly patients

Abstract Background: Esophagojejunostomy poses a significant challenge in the context of totally laparoscopic total gastrectomy (TLTG). The objective of this study was to compare the feasibility and safety of two distinct anastomotic techniques, namely hand-sewn anastomosis and functional end-to-end (FETE) anastomosis, in elderly patients undergoing TLTG. Methods: The clinical data of 28 elderly patients aged ≥ 60 years who underwent TLTG at Ningbo Medical Center Lihuili Hospital (Xingning hospital district) between January 2020 and December 2023 were retrospectively analyzed, and the clinical experiences were comprehensively examined and summarized Results: There were 15 cases in hand-sewn anastomosis group and 13 cases in FETE anastomosis group. The two groups exhibited disparities in terms of the distance from the tumor's upper margin to the esophageal resection margin, duration of surgery, and utilization of intraoperative gastroscopy. In the hand-sewn anastomosis group, the mean distance from the tumor's upper margin to the esophageal resection margin was 1.8 cm. Intraoperative gastroscopy was employed in 13 cases, with an average operative duration of 404 minutes. In the FETE anastomosis group, the the mean distance from the tumor's upper margin to the esophageal resection margin, no patients used intraoperative gastroscopy, and the average operation time was 265 minutes Conclusion: The hand-sewn anastomosis is deemed suitable for patients with a high anastomosis position, however, its execution poses challenges and consumes considerable time. The fete anastomosis technique is characterized by its efficiency and simplicity; however, it poses a significant risk for patients with a high anastomotic site.