Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy Sang-Woong Lee1*, Nobuhiko Tanigawa1,2, Eiji Nomura1, Takaya Tokuhara1, Masaru Kawai1, Kazutake Yokoyama1, Masako Hiramatsu1, Junji Okuda1 and Kazuhisa Uchiyama1
Abstract Background: Laparoscopic gastrectomy has recently been gaining popularity as a treatment for cancer; however, little is known about the benefits of intracorporeal (IC) gastrointestinal anastomosis with pure laparoscopic distal gastrectomy (LDG) compared with extracorporeal (EC) anastomosis with laparoscopy-assisted distal gastrectomy (LADG). Methods: Between June 2000 and December 2011, we assessed 449 consecutive patients with early-stage gastric cancer who underwent LDG. The patients were classified into three groups according to the method of reconstruction LADG followed by EC hand-sewn anastomosis (LADG + EC) (n = 73), using any of three anastomosis methods (Billroth-I (B-I), Billroth-II (B-II) or Roux-en-Y (R-Y); LDG followed by IC B-I anastomosis (LDG + B-I) (n = 248); or LDG followed by IC R-Y anastomosis (LDG + R-Y) (n = 128)). The analyzed parameters included patient and tumor characteristics, operation details, and post-operative outcomes. Results: The tumor location was significantly more proximal in the LDG + R-Y group than in the LDG + B-I group (P < 0.01). Mean operation time, intra-operative blood loss, and the length of post-operative hospital stay were all shortest in the LDG + B-I group (P < 0.05). Regarding post-operative morbidities, anastomosis-related complications occurred significantly less frequently in with the LDG + B-I group than in the LADG + EC group (P < 0.01), whereas there were no differences in the other parameters of patients’ characteristics. Conclusions: Intracorporeal mechanical anastomosis by either the B-I or R-Y method following LDG has several advantages over at the LADG + EC, including small wound size, reduced invasiveness, and safe anastomosis. Although additional randomized control studies are warranted to confirm these findings, we consider that pure LDG is a useful technique for patients with early gastric cancer. Keywords: Laparoscopic distal gastrectomy, Intracorporeal anastomosis, Extracorporeal anastomosis, Billroth I, Roux-en-Y
Background Since the technique of laparoscopy-assisted Billroth-I gastrectomy was first reported by Kitano and colleagues in 1994 [1], laparoscopic gastrectomy for cancer (LGC) has been gaining increasing popularity worldwide because it is associated with earlier patient recovery compared with open surgery [2-4]. A national survey conducted by * Correspondence: [email protected] 1 Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7, Daigaku-Machi, Takatsuki City Osaka 569-8686, Japan Full list of author information is available at the end of the article
the Japan Society of Endoscopic Surgery (JSES) every 2 years has shown increasing use of laparoscopic procedures for gastric
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