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Surgical Endoscopy

, Volume 25, Issue 4, pp 1076–1082 | Cite as

A totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG) for improvement of the early surgical outcomes in high BMI patients

  • Min Gyu Kim
  • Hironori Kawada
  • Beom Su Kim
  • Tae Hwan Kim
  • Kap Choong Kim
  • Jeong Hwan Yook
  • Byung Sik KimEmail author
Article

Abstract

Objective

To evaluate the effectiveness of totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG), we compared its early surgical outcomes with those of laparoscopy-assisted distal gastrectomy with gastroduodenostomy (LADG).

Methods

We retrospectively analyzed early surgical outcomes in 567 patients who underwent laparoscopic gastrectomy for gastric cancer between January 2009 and March 2010. The patients were divided into those with underwent TLDG and those with underwent LADG. Their surgical outcomes were analyzed according to the WHO Asia–Pacific Obesity classification.

Results

In overall patients, TLDG showed the significant results of early surgical outcomes. But more importantly, in the analysis of early surgical outcomes for obese patients, we found that TLDG could improve overall complication rate (p = 0.031), time to first flatus (p = 0.009), time to commencement of soft diet (p < 0.001), administration of analgesics (p = 0.019), pain score (Numeric Rating Scale, NRS), and hospital discharge (p = 0.003).

Conclusions

We suggested that TLDG contributes to the improvement of early surgical outcomes. We further suggest that TLDG in obese patients could be the best way to improve early surgical outcomes, including the bowel movement, pain score, overall complication rate, and hospital discharge.

Keywords

Laparoscopy-assisted distal gastrectomy Totally laparoscopic distal gastrectomy 

Notes

Disclosures

Drs. Min Gyu Kim, Bum Su Kim, Tae Hwan Kim, Kap Choong Kim, Jeong Hwan Yook, and Byung Sik Kim have no conflicts of interest or financial ties to disclose.

Conflict of interest

None.

References

  1. 1.
    Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S (2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135:806–810PubMedCrossRefGoogle Scholar
  2. 2.
    Asao T, Hosouchi Y, Nakabayashi T, Haga N, Mochiki E, Kuwano H (2001) Laparoscopically assisted total or distal gastrectomy with lymph node dissection for early gastric cancer. Br J Surg 88:128–132PubMedCrossRefGoogle Scholar
  3. 3.
    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 19:1172–1176PubMedCrossRefGoogle Scholar
  4. 4.
    Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727PubMedCrossRefGoogle Scholar
  5. 5.
    Kitano S, Shiraishi N, Kakisako K, Yasuda K, Inomata M, Adachi Y (2002) Laparoscopy-assisted Billroth-I gastrectomy (LADG) for cancer: our 10 years’ experience. Surg Laparosc Endosc Percutan Tech 12:204–207PubMedCrossRefGoogle Scholar
  6. 6.
    Lee JH, Han HS (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173PubMedCrossRefGoogle Scholar
  7. 7.
    Lee SI, Choi YS, Park DJ, Kim HH, Yang HK, Kim MC (2006) Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy. J Am Coll Surg 202:874–880PubMedCrossRefGoogle Scholar
  8. 8.
    Mochiki E, Toyomasu Y, Ogata K, Andoh H, Ohno T, Aihara R, Asao T, Kuwano H (2008) Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer. Surg Endosc 22:1997–2002PubMedCrossRefGoogle Scholar
  9. 9.
    Park JM, Jin SH, Lee SR, Kim H, Jung IH, Cho YK, Han SU (2008) Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases. Surg Endosc 22:2133–2139PubMedCrossRefGoogle Scholar
  10. 10.
    Ryu KW, Kim YW, Lee JH, Nam BH, Kook MC, Choi IJ, Bae JM (2008) Surgical complications and the risk factors of laparoscopy-assisted distal gastrectomy in early gastric cancer. Ann Surg Oncol 15:1625–1631PubMedCrossRefGoogle Scholar
  11. 11.
    Sakuramoto S, Kikuchi S, Kuroyama S, Futawatari N, Katada N, Kobayashi N, Watanabe M (2006) Laparoscopy-assisted distal gastrectomy for early gastric cancer: experience with 111 consecutive patients. Surg Endosc 20:55–60PubMedCrossRefGoogle Scholar
  12. 12.
    Song KY, Kim SN, Park CH (2008) Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects. Surg Endosc 22:655–659PubMedCrossRefGoogle Scholar
  13. 13.
    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMedGoogle Scholar
  14. 14.
    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 195:284–287PubMedCrossRefGoogle Scholar
  15. 15.
    Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, Park SM (2008) Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 22:436–442PubMedCrossRefGoogle Scholar
  16. 16.
    Song KY, Park CH, Kang HC, Kim JJ, Park SM, Jun KH, Chin HM, Hur H (2008) Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy? Prospective, multicenter study. J Gastrointest Surg 12:1015–1021PubMedCrossRefGoogle Scholar
  17. 17.
    Tanimura S, Higashino M, Fukunaga Y, Takemura M, Nishikawa T, Tanaka Y, Fujiwara Y, Osugi H (2008) Intracorporeal Billroth 1 reconstruction by triangulating stapling technique after laparoscopic distal gastrectomy for gastric cancer. Surg Laparosc Endosc Percutan Tech 18:54–58PubMedCrossRefGoogle Scholar
  18. 18.
    Ojima T, Iwahashi M, Nakamori M, Nakamura M, Naka T, Ishida K, Ueda K, Katsuda M, Iida T, Tsuji T, Yamaue H (2009) Influence of overweight on patients with gastric cancer after undergoing curative gastrectomy. Arch Surg 144:351–358PubMedCrossRefGoogle Scholar
  19. 19.
    Lee HJ, Kim HH, Kim MC, Ryu SY, Kim W, Song KY, Cho GS, Han SU, Hyung WJ, Ryu SW (2009) The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer. Surg Endosc 23:2473–2479PubMedCrossRefGoogle Scholar
  20. 20.
    Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Soga R, Wakayama A, Okamoto K, Ohyama A, Hasumi A (1999) Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer 2:186–190PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Min Gyu Kim
    • 1
  • Hironori Kawada
    • 1
  • Beom Su Kim
    • 1
  • Tae Hwan Kim
    • 1
  • Kap Choong Kim
    • 1
  • Jeong Hwan Yook
    • 1
  • Byung Sik Kim
    • 1
    • 2
    Email author
  1. 1.Department of Gastric SurgeryUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulRepublic of Korea
  2. 2.Division of Gastric Surgery, Department of Surgery, Asan Medical CenterUlsan UniversitySeoulRepublic of Korea

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