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. 2012 Dec 12;10:267.
doi: 10.1186/1477-7819-10-267.

Benefits of Intracorporeal Gastrointestinal Anastomosis Following Laparoscopic Distal Gastrectomy

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Free PMC article

Benefits of Intracorporeal Gastrointestinal Anastomosis Following Laparoscopic Distal Gastrectomy

Sang-Woong Lee et al. World J Surg Oncol. .
Free PMC article

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.

Figures

Figure 1
Figure 1
Intracorporeal Billroth I anastomosis. (A) A side-to-side gastroduodenostomy was formed by firing the 45-mm linear stapler; and (B) the common enterotomy was closed with two further firings of the stapler.
Figure 2
Figure 2
Intracorporeal Roux-en-Y anastomosis. (A) A side-to-side gastrojejunostomy was performed by firing a 60-mm linear stapler, then the remaining enterotomy was closed with a further firing of the linear stapler. (B) An end-to-side jejunojejunostomy was created between the descending alimentary jejunum and the biliopancreatic jejunum, using a linear stapler and sutures.

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