Surgical Endoscopy

, Volume 30, Issue 10, pp 4286–4293 | Cite as

Body composition changes after totally laparoscopic distal gastrectomy with delta-shaped anastomosis: a comparison with conventional Billroth I anastomosis

  • Ki Bum ParkEmail author
  • Oh Kyoung Kwon
  • Wansik Yu
  • Byeong-Churl Jang



The purpose of this study was to compare body composition changes of patients undergoing totally laparoscopic distal gastrectomy (TLDG) with delta-shaped anastomosis (DSA) versus conventional laparoscopic distal gastrectomy (CLDG).


Data from gastric cancer patients who underwent laparoscopic distal gastrectomy for histologically proven gastric cancer in KNUMC from January 2013 to May 2014 were collected and reviewed. We examined 85 consecutive patients undergoing TLDG or CLDG: 41 patients underwent TLDG and 44 patients underwent CLDG. Body composition was assessed by segmental multifrequency bioelectrical impedance analysis. We compared the changes in nutritional parameters and body composition from preoperative status between the two groups at postoperative 6 and 12 months.


All of the postoperative changes in the body composition and nutritional indices were similar between the two groups with the exception of visceral fat areas (VFAs) and albumin levels. VFAs increased at 6 months postoperatively in the TLDG group and a significant difference was shown at 12 months postoperatively between the TLDG and CLDG groups (86.7 ± 22.8 and 74.7 ± 21.9 cm2, respectively, P < 0.05). Postoperative albumin levels were higher in the TLDG group with statistical significance at 6 and 12 months after surgery (6 months, P = 0.028; 12 months, P = 0.012).


The influence of TLDG with DSA on nutrition and body composition seemed comparable to those of CLDG. Six months postoperatively, VFAs and albumin levels were recovered in the TLDG group but not in the CLDG group. Thus, TLDG seems to be a novel surgical method.


Body composition Gastric cancer Delta-shaped anastomosis Laparoscopic surgery 


Compliance with ethical standards


Drs. Ki Bum Park, Oh Kyoung Kwon, Wansik Yu, and Byeong-Churl Jang have no conflicts of interest or financial ties to disclose.


  1. 1.
    Armbrecht U, Lundell L, Lindstedt G, Stockbruegger RW (1988) Causes of malabsorption after total gastrectomy with Roux-en-Y reconstruction. Acta Chir Scand 154(1):37–41PubMedGoogle Scholar
  2. 2.
    Adams JF (1967) The clinical and metabolic consequences of total gastrectomy. I. Morbidity, weight, and nutrition. Scand J Gastroenterol 2(2):137–149CrossRefPubMedGoogle Scholar
  3. 3.
    Katsube T, Konnno S, Murayama M, Kuhara K, Sagawa M, Yoshimatsu K, Shiozawa S, Shimakawa T, Naritaka Y, Ogawa K (2008) Changes of nutritional status after distal gastrectomy in patients with gastric cancer. Hepatogastroenterology 55(86–87):1864–1867PubMedGoogle Scholar
  4. 4.
    Kiyama T, Mizutani T, Okuda T, Fujita I, Tokunaga A, Tajiri T, Barbul A (2005) Postoperative changes in body composition after gastrectomy. J Gastrointest Surg 9(3):313–319CrossRefPubMedGoogle Scholar
  5. 5.
    Mochiki E, Nakabayashi T, Kamimura H, Haga N, Asao T, Kuwano H (2002) Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer. World J Surg 26(9):1145–1149CrossRefPubMedGoogle Scholar
  6. 6.
    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(6):874–880CrossRefPubMedGoogle Scholar
  7. 7.
    Cheng Q, Pang TC, Hollands MJ, Richardson AJ, Pleass H, Johnston ES, Lam VW (2014) Systematic review and meta-analysis of laparoscopic versus open distal gastrectomy. J Gastrointest Surg 18(6):1087–1099CrossRefPubMedGoogle Scholar
  8. 8.
    Oki E, Sakaguchi Y, Ohgaki K, Saeki H, Chinen Y, Minami K, Sakamoto Y, Toh Y, Kusumoto T, Maehara Y (2011) Feasibility of delta-shaped anastomoses in totally laparoscopic distal gastrectomy. Eur Surg Res 47(4):205–210CrossRefPubMedGoogle Scholar
  9. 9.
    Lee HH, Song KY, Lee JS, Park SM, Kim JJ (2014) Delta-shaped anastomosis, a good substitute for conventional Billroth I technique with comparable long-term functional outcome in totally laparoscopic distal gastrectomy. Surg Endosc 29(9):2545–2552CrossRefPubMedGoogle Scholar
  10. 10.
    Kitagami H, Morimoto M, Nozawa M, Nakamura K, Tanimura S, Murakawa K, Murakami Y, Kikuchi K, Ushigome H, Sato L, Yamamoto M, Shimizu Y, Hayakawa T, Tanaka M, Hirano S (2014) Evaluation of the delta-shaped anastomosis in laparoscopic distal gastrectomy: midterm results of a comparison with Roux-en-Y anastomosis. Surg Endosc 28(7):2137–2144CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    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(2):284–287CrossRefPubMedGoogle Scholar
  12. 12.
    Fujiwara M, Kodera Y, Kasai Y, Kanyama Y, Hibi K, Ito K, Akiyama S, Nakao A (2003) Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma: a review of 43 cases. J Am Coll Surg 196(1):75–81CrossRefPubMedGoogle Scholar
  13. 13.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376CrossRefPubMedGoogle Scholar
  14. 14.
    Lee JH, Yom CK, Han HS (2009) Comparison of long-term outcomes of laparoscopy-assisted and open distal gastrectomy for early gastric cancer. Surg Endosc 23(8):1759–1763CrossRefPubMedGoogle Scholar
  15. 15.
    Han G, Park JY, Kim YJ (2014) Comparison of short-term postoperative outcomes in totally laparoscopic distal gastrectomy versus laparoscopy-assisted distal gastrectomy. J Gastric Cancer 14(2):105–110CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kanaya S, Kawamura Y, Kawada H, Iwasaki H, Gomi T, Satoh S, Uyama I (2011) The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer 14(4):365–371CrossRefGoogle Scholar
  17. 17.
    Jacobs DO, Robinson MK (1996) Body composition. In: Fischer JE (ed) Nutrition and metabolism in the surgical patient, 2nd edn. Little, Brown and CO, Boston, pp 3–26Google Scholar
  18. 18.
    Bae JM, Park JW, Yang HK, Kim JP (1998) Nutritional status of gastric cancer patients after total gastrectomy. World J Surg 22(3):254–260CrossRefPubMedGoogle Scholar
  19. 19.
    Ukleja A (2005) Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract 20(5):517–525CrossRefPubMedGoogle Scholar
  20. 20.
    Rivera I, Ochoa-Martinez CI, Hermosillo-Sandoval JM, Morales-Amezcua JM, Fuentes-Orozco C, Gonzalez-Ojeda A (2007) Dumping syndrome in patients submitted to gastric resection. Cir Cir 75(6):429–434PubMedGoogle Scholar
  21. 21.
    Tack J, Arts J, Caenepeel P, De Wulf D, Bisschops R (2009) Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol 6(10):583–590CrossRefPubMedGoogle Scholar
  22. 22.
    Tack J, Deloose E (2014) Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies. Best Pract Res Clin Gastroenterol 28(4):741–749CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Ki Bum Park
    • 1
    Email author
  • Oh Kyoung Kwon
    • 1
  • Wansik Yu
    • 1
  • Byeong-Churl Jang
    • 2
  1. 1.Gastric Cancer CenterKyungpook National University Medical CenterDaeguRepublic of Korea
  2. 2.Department of Molecular Medicine, College of MedicineKeimyung UniversityDaeguRepublic of Korea

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