Surgical Endoscopy

, Volume 28, Issue 4, pp 1250–1255 | Cite as

Surgical outcomes in the newly introduced phase of intracorporeal anastomosis following laparoscopic distal gastrectomy is safe and feasible compared with established procedures of extracorporeal anastomosis

  • Shingo Kanaji
  • Hitoshi Harada
  • Shunji Nakayama
  • Takashi Yasuda
  • Taro Oshikiri
  • Kentaro Kawasaki
  • Masashi Yamamoto
  • Tatsuya Imanishi
  • Tetsu Nakamura
  • Satoshi Suzuki
  • Kenichi Tanaka
  • Yasuhiro Fujino
  • Masahiro Tominaga
  • Yoshihiro Kakeji
Article

Abstract

Background

Totally laparoscopic distal gastrectomy (TLDG) with intracorporeal anastomosis has been introduced to achieve safer anastomosis with good vision, and a small wound. However, little is known about the surgical outcomes of newly introduced TLDG compared with established procedures of laparoscopy-assisted gastrectomy (LADG) with extracorporeal anastomosis.

Methods

This retrospective study included 114 patients who underwent laparoscopic distal gastrectomy (LDG) between January 2010 and September 2012. The patients were classified into two groups according to the approach of reconstruction (LADG group: n = 74; TLDG group: n = 40). The parameters analyzed included patients, operation details, and operative outcomes.

Results

No complication was observed in the TLDG group. Surgical outcomes of the TLDG group, such as mean operation time, estimated blood loss, and rate of conversion to laparotomy were not inferior to the LADG group. Furthermore, postoperative hospital stay of the TLDG group was significantly shorter than the LADG group (p < 0.05).

Conclusion

Surgical outcomes in the newly introduced phase of TLDG were safe as well as feasible compared with established LADG. TLDG has several advantages over LADG, such as shorter post-hospital stay, no incidence of operative complication, adequate working space, and small wound size. Although prospective, randomized control studies are warranted, we submit that TLDG can be used as a standard procedure for LDG.

Keywords

Laparoscopy Distal gastrectomy LADG TLDG Intracorporeal anastomosis Retrospective 

References

  1. 1.
    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMedGoogle Scholar
  2. 2.
    Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Tanimura S, Higashino M, Fukunaga Y, Takemura M, Tanaka Y, Fujiwara Y, Osugi H (2008) Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc 22:1161–1164PubMedCrossRefGoogle Scholar
  4. 4.
    Lee SW, Nomura E, Bouras G, Tokuhara T, Tsunemi S, Tanigawa N (2010) Long-term oncologic outcomes from laparoscopic gastrectomy for gastric cancer: a single-center experience of 601 consecutive resections. J Am Coll Surg 211:33–40PubMedCrossRefGoogle Scholar
  5. 5.
    Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    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
  7. 7.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112CrossRefGoogle Scholar
  9. 9.
    Lee SW, Tanigawa N, Nomura E, Tokuhara T, Kawai M, Yokoyama K, Hiramatsu M, Okuda J, Uchiyama K (2012) Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy. World J Surg Oncol 12:267–274CrossRefGoogle Scholar
  10. 10.
    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
  11. 11.
    Kim MC, Jung GJ, Kim HH (2005) Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 11:7508–7511PubMedGoogle Scholar
  12. 12.
    Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y (2013) Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg. doi:10.1097/SLA.0b013e31828dfa5d Google Scholar
  13. 13.
    Noh SH, Hyung WJ, Cheong JH (2005) Minimally invasive treatment for gastric cancer: approaches and selection process. J Surg Oncol 90:188–193PubMedCrossRefGoogle Scholar
  14. 14.
    Shiraishi N, Yasuda K, Kitano S (2006) Laparoscopic gastrectomy with lymph node dissection for gastric cancer. Gastric Cancer 9:167–176PubMedCrossRefGoogle Scholar
  15. 15.
    Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M (2003) Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients of heavier weight? Ann Surg 238:680–685PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Shingo Kanaji
    • 1
  • Hitoshi Harada
    • 2
  • Shunji Nakayama
    • 2
  • Takashi Yasuda
    • 2
  • Taro Oshikiri
    • 2
  • Kentaro Kawasaki
    • 2
  • Masashi Yamamoto
    • 1
  • Tatsuya Imanishi
    • 1
  • Tetsu Nakamura
    • 1
  • Satoshi Suzuki
    • 1
  • Kenichi Tanaka
    • 1
  • Yasuhiro Fujino
    • 2
  • Masahiro Tominaga
    • 2
  • Yoshihiro Kakeji
    • 1
  1. 1.Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of MedicineKobe UniversityKobeJapan
  2. 2.Department of Gastroenterogical SurgeryHyogo Cancer CenterHyogoJapan

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