Background: The purpose of this study is to depict a novel delta-shaped intracorporeal double-tract reconstruction (DT) for totally laparoscopic (TL) proximal gastrectomy (PG), and to evaluate its safety and feasibility by analyzing its surgical and postoperative outcomes.
Patients and methods: We retrospectively reviewed the cases of 21 patients who underwent TLPG and TLDT (TLPG-DT) from January to December 2014 in our hospital. The data of clinicopathologic characteristics, surgical and postoperative outcomes, and follow-up findings were collected and analyzed.
Results: The mean duration of the operation was 173.8 ± 21.8 min, including 27.8 ± 5.3 min of reconstruction. The blood loss was 109.2 ± 96.3 mL. The mean number of LNs dissected was 25.7 ± 4.7. The mean time of the first flatus was at postoperative day 2.3 ± 1.0, and the mean postoperative hospital stay was 6.8 ± 2.5 days. The early complications rate was 9.5 %, including one intraperitoneal hemorrhage and one pulmonary infection (both were managed through conservative methods and no re-operation occurred). The rate of complications in late stage was also 9.5 %, including one diarrhea and one reflux symptom claim. Among the total 21 cases, 17 patients were followed up more than 6 months, showing no signs of reflux esophagitis or anastomotic stenosis. The mean weight loss in 3 and 6 months after the operation was 4.3 and 5.7 %, respectively.
Conclusion: Totally laparoscopic delta-shaped intracorporeal double-tract reconstruction is a safe, feasible and minimally invasive reconstruction method with excellent postoperative outcomes in terms of preventing reflux esophagitis and anastomotic stenosis. TLPG-DT might serve as a promising treatment for proximal gastric cancer of early stage.
Keywords: Delta-shaped anastomosis; Double-tract reconstruction; Endoscopic linear stapler; Totally laparoscopic proximal gastrectomy.