Delta-Shaped Gastroduodenostomy after Totally Laparoscopic Distal Gastrectomy: A Comparison Analysis between Early and Late Experience

Stapling an extracorporeal Billroth-I anastomosis by the complete double stapling technique after laparoscopy-assisted distal gastrectomy

INTRODUCTION

Laparoscopy-assisted distal gastrectomy is one of the major treatments for early stage gastric cancer, particularly in the East Asia. In this method, extracorporeal anastomosis is performed via a small laparotomy wound, but excessive tissue traction may be encountered during the anastomotic procedure. Therefore, we developed an original procedure for extracorporeal Billroth-I reconstruction: end-to-end stapling gastroduodenostomy with complete double stapling technique. This procedure aims to reduce the problems related to maneuvers through a small laparotomy.

METHODS

An end-to-end anastomosis is constructed on the transection line using a circular stapler inserted from the distal end of the greater curvature of the remnant stomach. Short-term outcomes were reviewed in 218 consecutive patients who underwent complete double stapling technique reconstruction after laparoscopy-assisted distal gastrectomy between 2002 and 2012. Findings from GI endoscopy were reviewed in 110 patients.

RESULTS

The mean operative time was 216 min, and mean blood loss was 163 mL. There was no conversion to the open surgery and no operative death. Eight patients (3.6%) had anastomosis-related postoperative complications. In follow-up endoscopic examinations 1 year after surgery, grade 3 or higher residual food was seen in 17.2% of patients. Gastritis extending to the entire remnant stomach was observed in 8.2% of patients, and grade 3 gastritis was seen in 2.7%. Los Angeles classification grade A or higher reflux esophagitis was found in 10.9%.

CONCLUSIONS

Billroth-I reconstruction by the complete double stapling technique is a safe and feasible procedure. This method provides satisfactory short-term outcomes, including the incidence of reflex remnant gastritis and esophagitis.

Modified intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: early experience

Purpose

This study presents findings on the clinical usefulness of an overlap method that is another modification for the currently well-known intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG).

Methods

We studied 42 patients diagnosed with gastric cancer who underwent TLDG between December 2011 and March 2013. Endoscopic linear staplers were used for intracorporeal anastomosis and patients were observed with endoscopic tracking six months after surgery. We retrospectively reviewed the outcome of the operation, the clinical pathological results, and the endoscopy results.

Results

The mean duration of the operation for 42 patients was 228.3 ± 42.5 minutes and the mean time to complete the anastomosis was 12.18 ± 2.3 minutes. There were no mortalities and no cases of open conversion. Following the operation, 37 patients had stage IA, 5 in stage IB, and 3 in stage II gastric cancer. Abscesses were seen in 3 patients and 5 cases of stasis during the postoperative period. Duodenoscopy 6 months after the operation showed 11 cases of gastric stasis, 28 cases of bile reflux, and 1 new case of erosive gastritis. We did not observe contraction in any of the patients.

Conclusion

The overlap method for intracorporeal gastroduodenostomy, using an endoscopic linear stapler, can be considered a feasible and safe technique for the treatment of stomach cancer. However, a long-term comparative study is required to sufficiently evaluate our findings.

Delta-shaped anastomosis, a good substitute for conventional Billroth I technique with comparable long-term functional outcome in totally laparoscopic distal gastrectomy

BACKGROUND

Delta-shaped anastomosis (DA) is a new Billroth I reconstruction technique using only a laparoscopic linear stapler under a totally laparoscopic approach. The present study compared the outcomes of DA with those of laparoscopic conventional Billroth I anastomosis (cBIA).

METHODS

A total of 138 and 100 patients with gastric cancer who underwent laparoscopic distal gastrectomy with DA and cBIA, respectively, were selected. Clinicopathological data and short- and long-term outcomes were compared between the two groups.

RESULTS

The mean operating time in the DA group was similar to that in the cBIA group. Short-term outcomes, such as bowel function recovery, morbidity, and mortality, did not differ between the DA and cBIA groups. There were no significant differences in the 5-year disease-free and overall survival rates between the two groups. All nutritional indices (body weight change, albumin level, transferrin level, and total lymphocyte count) were similar between the two groups with the exception of a few points in the early follow-up period. Endoscopic evaluation using the Residual food, Gastritis, Bile reflux classification revealed relatively better gastritis findings in the DA group despite worse bile reflux for 5 postoperative years. The food amount was significantly larger in the DA group for 2 postoperative years.

CONCLUSIONS

The outcomes of DA were comparable to those of cBIA. DA is a recommendable reconstruction method, especially in totally laparoscopic distal gastrectomy.