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The weakest link in laparoscopic gastrectomy is the esophageal anastomosis, the reliability of which, despite the large number of proposed techniques, remains insufficient. The article presents modern methods of intracorporeal esophageal anastomosis, assesses their advantages and disadvantages. Almost all techniques use a single-layered, mostly mechanical, suture. The probability of maintaining the tightness of a single-layered esophageal anastomosis in case of its healing by secondary tension is extremely small. The experience of open surgery has shown that the placement of the terminal esophagus and the first layer of sutures of anastomosis in a serous-muscular sheath, which is formed from the wall of the intestine or stomach using invagination or wrapping methods, provides a greater likelihood of maintaining the tightness of the anastomosis in any type of healing. Expanding indications for the use of these methods in open surgery and developing a technique for intracorporeal esophageal anastomosis with covering the first layer of sutures of anastomosis with the wall of the anastomosed organ seems to be a promising direction that can significantly reduce the incidence of anastomotic leak both in open and laparoscopic surgery.

Objective: To evaluate the effectiveness of intraoperative angiography and fluorescence navigation with indocyanine green in reducing the risks of intra- and postoperative complications, as well as resection quality in patients with gastric cancer., Material and Methods: The main group consisted of patients who underwent intraoperative angiography and fluorescence navigation with indocyanine green ( n =43). The control group included patients without these procedures ( n =154). Both groups did not differ in gender ( p =0.937) and age ( p =0.437). The lower third of the stomach was the most common tumor location in the main group (62.7% of cases), the middle and lower thirds of the stomach - in the control group (37% and 38.9% of patients, respectively). There was no between-group difference in «cT» grading ( p >0.05). However, there were more «cN+» patients in the main group (14 (32.6%) versus 28 (18.4%) ones of «N0» category, p =0.042). Therefore, 41.9% and 13.6% of patients underwent neoadjuvant chemotherapy in both groups, respectively (<0.001)., Results: Intraoperative angiography and fluorescence navigation with indocyanine green does not increase mortality ( p =0.631), incidence of major (CD 3-5) ( p =0.436) and minor (CD 1-2) postoperative complications ( p =0.177), surgery time ( p =0.288), mean intraoperative blood loss ( p =0.144) and length of hospital-stay ( p =0.631). Fluorescence navigation with indocyanine green does not affect the number of detected «positive» resection margins (R1) ( p =0.883) but significantly increases the number of excised lymph nodes ( p <0.001)., Conclusion: Intraoperative angiography and fluorescence navigation with indocyanine green are safe for intraoperative visualization of tumor and lymph nodes, as well as assessment of arterial blood supply. This technique is effective in traditional and minimally invasive surgeries for gastric cancer. Fluorescence navigation with indocyanine green significantly increases the number of excised lymph nodes.

The article analyzed the methods of suprapancretic lymph node dissection in laparoscopic gastrectomy which were developed and applied in Japan. The authors described the details of operation technique. There were noted the advantages of medial approach for suprapancreatic lymph node dissection.

Objective: To compare laparoscopic manual esophagoenterostomy and esophagoenterostomy with mechanical stapling anastomotic devices after laparoscopic gastrectomy for stomach cancer., Material and Methods: There were 34 patients who underwent laparoscopic gastrectomy for stomach in 2015-2018. Roux-en-Y esophagoenterostomy was used to reconstruct the gastrointestinal tract. Manual anastomoses were performed in 18 patients (group 1), stapled anastomoses (endogia 45 mm, covidien, mansfield, ma, usa) - in 16 patients (group 2). There was no randomization. Surgery duration, length of icu-stay, terms of enteral nutrition initiation, postoperative complications, hospital-stay were analyzed., Results: Mean duration of surgery in the first group was 217 (184-302) min, in the second group - 201 (162-311) min. Duration of surgery in the first group was 1.08-fold higher than in the second group (95% CI 1.03-1.13, p =0.05). Mean blood loss was 145 ml in both groups. Mean icu-stay was 20.2 (17-42) hours in the first group and 21.1 (16.2-46) hours in the second group (ratio 0.96, 95% CI 0.92-1.01, p =0.06). Total enteral feeding (sipping) was initiated on the third day in both groups. Mean postoperative hospital-stay was 9.21 (6-13) days in the first group and 9.23 (6-12 days) days in the second group (ratio 0.99, 95% CI 0,95-1.02, p =0.06). Postoperative morbidity was 5.5% in the first group and 6.25% in the second group., Conclusion: Laparoscopic manual esophagoenterostomy proposed by our surgical team does not have disadvantages in comparison with stapling anastomotic devices and these methods may be alternative to each other.