Totally Laparoscopic Total Gastrectomy with Oesophagus-Duodenal Interposition of a Pedicled Jejunal Flap in a Patient with Familial Adenomatous Polyposis (with video)

Introduction: Several interposition techniques have been described for reconstruction after total gastrectomy in FAP patients, in open (1) and laparoscopic assisted surgery (2,3,4). The Longmire technique has the advantage of allowing all the food to pass through the duodenum and better absorption of nutrients, such as iron (5). Here, we describe the use of a pedicled isoperistaltic jejunal flap interposition technique to reconstruct the digestive tract after total gastrectomy, fully performed by laparoscopic approach, in a patient with FAP that had previous total colectomy. Our patient was a 68-year-old woman, with “MUTYH-Associated Polyposis (MAP)”, a c.494A>G mutation at exon 7 and c.1145G>A mutation at exon 13. She was diagnosed with gastric cancer and lesions of high- and low-grade dysplasia. She was previously submitted to a laparoscopic total colectomy, 2009, and a conservative breast surgery plus chemoradiotherapy in 2017. She also had duodenal and rectum polyps in her surveillance months, without any relevant symptoms. Conclusion: We hereby describe a technique that has been previously used by others with good results, but with the novel contribution of performing the surgery entirely by laparoscopy.