Delta-Shaped Gastroduodenostomy in Fully Laparoscopic Distal Gastrectomy: A Retrospective Study

Application of double layered end-to-end anastomosis with continuous manual suture for completing digestive tract reconstruction in totally laparoscopic distal gastrectomy

Background

We retrospectively reviewed and consecutively collected the clinical data of distal gastric cancer patients who received surgical treatment, and we discuss the safety and feasibility of double layered end-to-end anastomosis with continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy.

Methods

We reviewed the clinical data of 41 patients with distal gastric cancer from the gastroenterology department of the Second Affiliated Hospital of Dalian Medical University, from September 2018 to August 2019, who underwent totally laparoscopic distal gastrectomy. During the operation, the method of double layered end-to-end anastomosis with continuous manual suture was used for Billroth type I anastomosis to complete digestive tract reconstruction. All patients have been given a follow-up visit and gastroscopy three months after the operation. The peri-operative clinical information and postoperative follow-up information were collected for analysis, and the clinical application value was evaluated.

Results

General information: male(n = 27), female(n = 14), age = 65.02(SD 9.94) years, and BMI = 23.52(SD 2.56) kg/m², Tumor location: antrum(32,78.0%), angle (6,14.6%), and body (3,7.3%). Clinical stage: I (27, 65.9%), II (7, 17.1%), and III (7, 17.1%). Operative information: operation time = 154.51(SD 33.37) min, anastomosis time = 26.88(SD 5.11) min; intraoperative bleeding = 66.34(SD 48.81) ml; first postoperative ambulation Median = 1(IQR 0) d, first postoperative flatus Median = 3(IQR 2) d, first postoperative diet Median = 3(IQR 1) d, postoperative hospital stay Median = 7(IQR 2) d, and total hospitalization cost = 10,935.00(SD 2205.72)USD. Differentiation degree: high and high-moderate (3,7.32%), moderate and poor-moderate (24, 58.54%), poor differentiation (14, 34.15%), dissected lymph nodes Median = 31(IQR 17), and positive lymph nodes Median = 0(IQR 1). Pathological stage: IA (20, 48.78%), IB (3, 7.32%), IIA (4, 9.76%), IIB (5, 12.20%), IIIA (1, 2.44%), IIIB (3, 7.32%), and IIIC (5, 12.20%). Complications (n = 4): lung infection (1, 2.44%), anastomotic leakage (1, 2.44%), and gastroparesis (2, 4.88%).

Conclusion

It is safe and feasible in clinical treatment to apply the method of double layered end-to-end anastomosis with continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy.

Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer

In addition to the popularity of laparoscopic gastrectomy (LG), many reconstructive procedures after LG have been reported. Surgical resection and lymphatic dissection determine long-term survival; however, the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer (GC). Presently, no consensus exists regarding the optimal reconstructive procedure. In this review, the current state of digestive tract reconstruction after LG is reviewed. According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction, we divide these reconstruction procedures into three categories consistent with the resection procedures. We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes (length of surgery and blood loss) and postoperative complications (anastomotic leakage and stricture) to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.

Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal isoperistaltic ileocolic anastomosis for colon cancer: An evaluation of short-term outcomes

Laparoscopic right hemicolectomy with extracorporeal anastomosis is a widely used procedure; several authors have published their approach to intracorporeal anastomosis. In this paper, we present an approach developed by us and compare short-term outcomes with those of extracorporeal anastomosis in colon cancer patients.Retrospective review of colon cancer patients treated with laparoscopic right hemicolectomy either with intracorporeal anastomosis (TLG group) or extracorporeal anastomosis (LG group) at the Zhangjiagang Hospital Affiliated to Soochow University between January 2011 and October 2015. Operative and postoperative data are compared.Around 85 patients underwent laparoscopic hemicolectomy (56 TLG and 29 LG) during the reference period for this study. Age, gender, body mass index (BMI), stage of cancer, operation time, number of lymph nodes harvested, and length of hospital stay were comparable between the 2 groups. In the TLG group, the ileocolic anastomosis time was significantly shorter (9.9-15.5 minutes vs 13.5-18.2 minutes in LG; P < 0.001), the mean intraoperative blood loss was lower (83.2 mL [range, 56.5-100.5 mL] vs 93.3 mL [range, 75.8 - 110.3 mL]; P < 0.001), the recovery of bowel function was faster (P < 0.001), and the postoperative pain score was lower (P < 0.001) as compared to that in the LG group. Complications in the LG group included wound infection (4 patients), obstruction (1), and postoperative bleeding complications (1); however, only 1 patient developed complication (wound infection) in the TLG group.Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal anastomosis for colon cancer is a safe and reliable procedure. Its advantages include short anastomosis time, less intraoperative blood loss, less postoperative pain, and early bowel function recovery.