{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:04:05Z","timestamp":1788390245595,"version":"build-2803163510"},"reference-count":49,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: In contrast to the standardization of laparoscopic gastrectomy techniques, the complexity of intracorporeal anastomosis techniques in totally laparoscopic total gastrectomy, the lack of standardization, the positional challenges posed by working in a confined space, and varying complication rates have prevented a consensus on the optimal intracorporeal digestive tract reconstruction method. Selecting an appropriate reconstruction method for esophagojejunostomy is crucial for a successful surgical outcome. This study aims to define a modified anastomotic technique for TLTG and share our experience with this technique. Materials and Methods: A total of 21 patients who underwent TLTG with D2 LND between July 2024 and December 2024 using the sutureless L-shape esophagojejunostomy (SLEJ) technique at the Surgical Oncology Clinic of Gulhane Training and Research Hospital due to gastric cancer were included in the study. In our technique, gastrectomy, lymph node dissection, anastomosis preparation, esophagojejunostomy anastomosis, and enteroenterostomy anastomosis were all performed laparoscopically and intracorporeally. Results: The mean operative time was 180.48 min, with a mean EJ anastomosis duration of 40.24 min. In the standard technique, two Endo GIA\u2122 staplers were used for pyloric and small bowel transection, two for EJ anastomosis, and one for intracorporeal jejunojejunostomy. In only one patient, three staplers were used for anastomosis. Therefore, the average number of staplers was 5.05, with a mean of 2.05 staplers used for anastomosis. The mean hospital stay was 8.19 days, and there were no mortalities. The number of patients with an anastomotic leakage was 1. Since the patient\u2019s general condition remained stable, percutaneous drainage or laparotomy was not planned. The patients\u2019 esophagojejunostomy anastomotic leak was classified as Class 1 and Grade 3a according to the Clavien\u2013Dindo classification. The average size of our widest incision was 3.28 cm, and surgical site infections were developed in two patients. Conclusions: Sutureless L-Shape With Endoscopic Assistance (SLEJ) is an easily applicable, technically simpler, shorter-in-duration, easier-to-learn, and safer intracorporeal EJ anastomosis technique with a low rate of postoperative complications.<\/jats:p>","DOI":"10.3390\/medicina61050795","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T06:10:13Z","timestamp":1745561413000},"page":"795","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Novel and Feasible Intracorporeal Esophagojejunostomy Anastomosis in Totally Laparoscopic Total Gastrectomy Surgery: Sutureless L-Shape with Endoscopic Assistance (SLEJ)"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9417-3866","authenticated-orcid":false,"given":"Ibrahim Burak","family":"Bahcecioglu","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, Gulhane Research and Training Hospital, Ankara 06010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5069-1872","authenticated-orcid":false,"given":"Sumeyra","family":"Guler","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Gulhane Research and Training Hospital, Ankara 06010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0441-0333","authenticated-orcid":false,"given":"Sevket Baris","family":"Morkavuk","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Gulhane Faculty of Medicine, Health Sciences University, Ankara Gulhane Research and Training Hospital, Ankara 06010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7854-4855","authenticated-orcid":false,"given":"Mujdat","family":"Turan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Gulhane Faculty of Medicine, Health Sciences University, Ankara Gulhane Research and Training Hospital, Ankara 06010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0592-7521","authenticated-orcid":false,"given":"Gokhan Giray","family":"Akgul","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Gulhane Faculty of Medicine, Health Sciences University, Ankara Gulhane Research and Training Hospital, Ankara 06010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5642-3705","authenticated-orcid":false,"given":"Mirac Baris","family":"Erzincan","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Gulhane Research and Training Hospital, Ankara 06010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8496-539X","authenticated-orcid":false,"given":"Kubilay Kenan","family":"Ozluk","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Gulhane Research and Training Hospital, Ankara 06010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0067-3451","authenticated-orcid":false,"given":"Osman","family":"Bardakci","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Gulhane Research and Training Hospital, Ankara 06010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Ali","family":"Gulcelik","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Gulhane Faculty of Medicine, Health Sciences University, Ankara Gulhane Research and Training Hospital, Ankara 06010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA A Cancer J. 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