The physiological advantages of preserving the autonomic nerves in the mesojejunum in the reconstructed alimentary limb have been documented [12, 13], and in our institution, we sacrifice the jejunum to create an autonomic nerve-preserved jejunal limb for Roux-en-Y reconstruction.
We retrospectively evaluated our experience with overlap anastomosis with autonomic nerve-preserved mesojejunum for the lifted jejunal limb in laparoscopic distal gastrectomy with intentional regional lymph node dissection.
To preserve autonomic nerves in the distal mesojejunum, the jejunum was sacrificed as close to the jejunal wall as possible.
Overall, a lifted jejunal limb with autonomic nerve-preserved mesojejunum may provide an excellent postoperative course after distal gastrectomy, especially in early gastric cancer without intentional dissection of autonomic nerves.
We used overlap anastomosis with autonomic nerve-preserved mesojejunum with a lifted jejunal limb during laparoscopic distal gastrectomy, and we suggest that this isoperistaltic reconstruction with nerve preservation may have beneficial physiological potential.
The jejunum was sacrificed (blue dotted line), and then, the mesojejunum was transected to lift the jejunal limb (red dotted line).
(c) Through a small laparotomy, gaps in the mesojejunum could be closed even along the upper side of the mesocolon (red arrow).
Even subtle tension on the mesojejunum was avoided as much as possible by sacrificing the jejunum (blue solid arrow), and a well-defined mesojejunum in the lifted jejunal limb (red dotted arrow) effectively preserved the mesenteric autonomic nerves.
The peritoneum tends to release a fan-shaped formation, which holds the jejunum and ileum to the posterior abdominal wall, and is composed of two layers, having a sufficient extension to allow considerable mobility to this portion of small intestine; this formation is the mesentery, which will receive the prefixes of the organ where it is attending as the case of the mesojejunum
, demonstrated in Figure 5.