Surgical Endoscopy

, Volume 22, Issue 2, pp 436–442 | Cite as

Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience

  • Jin-Jo Kim
  • Kyo Young Song
  • Hyung Min Chin
  • Wook Kim
  • Hae Myung Jeon
  • Cho Hyun Park
  • Seung Man Park



We analyzed our preliminary clinical data for totally laparoscopic gastrectomy (TLG) in order to evaluate its effectiveness in terms of minimal invasiveness, technical feasibility, and safety.


Forty-five consecutive patients who underwent TLG in our institution between June 2004 and February 2006 were enrolled in this study. There were 26 men and 19 women, with a mean age of 58.8 years and a mean body mass index (BMI) of 23.2. In all cases, only laparoscopic linear staplers were used for intracorporeal anastomosis.


The reasons that gastrectomy was performed were adenocarcinoma in 41 cases, benign disease in three cases and gastrointestinal stromal tumor in one case, and the types of surgery were distal gastrectomy (40), total gastrectomy (four) and pylorus-preserving gastrectomy (one). Among the distal gastrectomies, Billroth I (25) was the most frequent procedure, followed by uncut Roux-en-Y gastrojejunostomy (14) and Billroth II (one), respectively. The mean operation time was 314 minutes, the mean anastomotic time was 41 minutes, the mean number of staples used was eight, and the mean estimated blood loss was 150 ml. There was no case of conversion to an open procedure. The first flatus was observed at 2.9 days, and liquid diet was started at 3.7 days. The mean number of postoperative analgesic use, except for patient-controlled analgesia (PCA), was 1.4 times, and the mean postoperative hospital stay was 11 days. Postoperative complication occurred in six patients (13.3 %), but no postoperative mortality occurred. There were two cases of delayed gastric empting and one case of anastomotic leakage, anastomotic stenosis, intraabdominal bleeding, and ventral hernia each. All of the patients recovered well with conservative or surgical management.


TLG with intracorporeal anastomosis using laparoscopic linear staplers was safe and feasible, and we were able to obtain acceptable surgical outcomes in terms of minimal invasiveness.


Laproscopy Gastrectomy Intracorporeal anastomosis Linear stapler 


  1. 1.
    Kim CY, Lee SY, Yang DH (2006) What is the prognosis for early gastric cancer with pN stage two or three at the time of pre-operation and operation. J Korean Gastric Cancer Assoc 6:114–119Google Scholar
  2. 2.
    Korean Laparoscopic GI Surgery Study Group (2005) Nationwide survey of laparoscopic gastric surgery in Korea, 2004. J Korean Gastric Cancer Assoc 5:295–303Google Scholar
  3. 3.
    Goh P, Tekant Y, Kum CK, Isaac J, Shang NS (1992) Totally intra-abdominal laparoscopic Billroth II gastrectomy. Surg Endosc 6:160CrossRefPubMedGoogle Scholar
  4. 4.
    Goh PM, Alponat A, Mak K, Kum CK (1997) Early international results of laparoscopic gastrectomies. Surg Endosc 11:650–652CrossRefPubMedGoogle Scholar
  5. 5.
    Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195:284–287CrossRefPubMedGoogle Scholar
  6. 6.
    Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, Park SM, Lim KW, Park WB, Kim SN (2005) The early experience with a totally laparoscopic distal gastrectomy. J Korean Gastric Cancer Assoc 5:16–22Google Scholar
  7. 7.
    UICC International Union Against Cancer (1997) TNM classification of malignant tumors. Fifth edition. Wiley New YorkGoogle Scholar
  8. 8.
    Japanese Gastric Cancer Association (1998) Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1:10–24CrossRefPubMedGoogle Scholar
  9. 9.
    Mulholland MW, Magallanes F, Quigley TM, Delaney JP (1983) In-continuity gastrointestinal stapling. Dis Colon Rectum 26:586–589CrossRefPubMedGoogle Scholar
  10. 10.
    Matsui H, Uyama I, Sugioka A, Fujita J, Komori Y, Ochiai M, Hasumi A (2002) Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy. Am J Surg 184:58–60CrossRefPubMedGoogle Scholar
  11. 11.
    Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173CrossRefPubMedGoogle Scholar
  12. 12.
    Kim MC, Kim KH, Kim HH, Jung GJ (2005) Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol 91:90–94CrossRefPubMedGoogle Scholar
  13. 13.
    Noshiro H, Nagai E, Shimizu S, Uchiyama A, Tanaka M (2005) Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc 19:1592–1596CrossRefPubMedGoogle Scholar
  14. 14.
    Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176CrossRefPubMedGoogle Scholar
  15. 15.
    Mochiki E, Kamiyama Y, Aihara R, Nakabayashi T, Asao T, Kuwano H (2005) Laparoscopic assisted distal gastrectomy for early gastric cancer: Five years’ experience. Surgery 137:317–322CrossRefPubMedGoogle Scholar
  16. 16.
    Fujiwara M, Kodera Y, Miura S, Kanyama Y, Yokoyama H, Ohashi N, Hibi K, Ito K, Akiyama S, Nakao A (2005) Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a phase II study following the learning curve. J Surg Oncol 91:26–32CrossRefPubMedGoogle Scholar
  17. 17.
    Nakajima T (2002) Gastric cancer treatment guidelines in Japan. Gastric Cancer 5:1–5CrossRefPubMedGoogle Scholar
  18. 18.
    Tu BN, Kelly KA (1995) Elimination of the Roux stasis syndrome using a new type of “uncut Roux” limb. Am J Surg 170:381–386CrossRefPubMedGoogle Scholar
  19. 19.
    Noh SM (2000) Improvement of the Roux limb function using a new type of “uncut Roux” limb. Am J Surg 180:37–40CrossRefPubMedGoogle Scholar
  20. 20.
    Mayers TM, Orebaugh MG (1998) Totally laparoscopic Billroth I gastrectomy. J Am Coll Surg 186:100–103CrossRefPubMedGoogle Scholar
  21. 21.
    Hyung WJ, Lim JS, Cheong JH, Kim J, Choi SH, Song SY, Noh SH (2005) Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy. Surg Endosc 19:1353–1357CrossRefPubMedGoogle Scholar
  22. 22.
    Tanimura S, Higashino M, Fukunaga Y, Osugi H (2003) Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 17:758–762CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Jin-Jo Kim
    • 1
    • 2
  • Kyo Young Song
    • 1
  • Hyung Min Chin
    • 1
  • Wook Kim
    • 1
  • Hae Myung Jeon
    • 1
  • Cho Hyun Park
    • 1
  • Seung Man Park
    • 1
  1. 1.Department of SurgeryCollege of Medicine, The Catholic University of KoreaSeocho-GuKorea
  2. 2.Department of SurgeryOur Lady of Mercy Hospital, College of Medicine, The Catholic University of KoreaBupyoung-GuKorea

Personalised recommendations