Journal of Gastrointestinal Surgery

, Volume 16, Issue 4, pp 738–743 | Cite as

Totally Laparoscopic Billroth II Gastrectomy with a Novel, Safe, Simple, and Time-Saving Anastomosis by Only Stapling Devices

  • Jianjun Du
  • Jianbo Shuang
  • Jipeng Li
  • Qingchuan Zhao
  • Liu Hong
  • Xiongwei Du
  • Jiazhi Wen
  • Jin Hua
Original Article
First Online:
Received:
Accepted:

Abstract

Background

Totally laparoscopic gastrectomy represents the evolution of laparoscopy-assisted gastrectomy. Most surgeons prefer laparoscopy-assisted gastrectomy rather than totally laparoscopic procedures because of technical difficulties of intracorporeal anastomosis. We created one novel stapling anastomosis without hand-sewn technique in totally laparoscopic Billroth II gastrectomy. The feasibility and early surgical outcomes of totally laparoscopic Billroth II gastrectomy with stapling anastomosis and with hand-sewn anastomosis were introduced in this study.

Methods

We retrospectively analyzed early surgical outcomes in 70 patients who underwent totally laparoscopic Billroth II distal gastrectomy for gastric cancer between January 2010 and July 2011. The patients were divided into hand-sewn and device groups according to whether intracorporeal anastomosis was performed by only hand-sewn technique (n = 36) or only stapling devices (n = 34). In the device group, the gastrojejunostomy was performed using a circular stapler, and an additional side-to-side jejunojejunostomy was made at the site of jejunal enterotomy.

Results

There was no difference in the mean number of lymph nodes retrieved in both groups. The blood loss (hand-sewn group 205.8 ± 37.4 vs. device group 201.2 ± 51.2 ml, p > 0.05) and hospital stay (hand-sewn group 6.5 ± 3.7 vs. device group 5.9 ± 4.1 days, p > 0.05) were similar in both groups. We found that intracorporeal anastomosis by totally stapling devices was associated with decreased operative time (hand-sewn group 239.0 ± 40.1 vs. device group 203.6 ± 27.9 min, p < 0.05).

Conclusion

We suggest that intracorporeal anastomosis using only stapling devices in the described method was as safe and feasible as by hand-sewn technique. Moreover, it is a simple and time-saving method without any difficult hand-sewn procedures.

Keywords

Totally laparoscopic distal gastrectomy Gastric cancer Stapling anastomosis 
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Notes

Acknowledgments

We thank Dr. David Hedley for English editing the manuscript.

References

  1. 1.
    Kachikwu EL, Trisal V, Kim J, Pigazzi A, Ellenhorn JD. Minimally invasive total gastrectomy for gastric cancer: a pilot series. J Gastrointest Surg 2011; 15:81–86.PubMedCrossRefGoogle Scholar
  2. 2.
    Tanimura S, Higashino M, Fukunaga Y, Kishida S, Ogata A, Fujiwara Y, Osugi H. Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Br J Surg 2007; 94:204–207.PubMedCrossRefGoogle Scholar
  3. 3.
    Kinoshita T, Shibasaki H, Oshiro T, Ooshiro M, Okazumi S, Katoh R. Comparison of laparoscopy-assisted and total laparoscopic Billroth-I gastrectomy for gastric cancer: a report of short-term outcomes. Surg Endosc 2011; 25:1395–1401.PubMedCrossRefGoogle Scholar
  4. 4.
    Ikeda O, Sakaguchi Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, Ohga T, Adachi E, Toh Y, Okamura T, Baba H. Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc 2009; 23:2374–2379.PubMedCrossRefGoogle Scholar
  5. 5.
    Kim MG, Kim KC, Kim BS, Kim TH, Kim HS, Yook JH, Kim BS. A totally laparoscopic distal gastrectomy can be an effective way of performing laparoscopic gastrectomy in obese patients (body mass index >/= 30). World J Surg 2011; 35:1327–1332.PubMedCrossRefGoogle Scholar
  6. 6.
    Roukos DH, Katsios C. Totally intracorporeal laparoscopic gastrectomy for gastric cancer. Surg Endosc 2010; 24:3247–3248.PubMedCrossRefGoogle Scholar
  7. 7.
    Dulucq JL, Wintringer P, Perissat J, Mahajna A. Completely laparoscopic total and partial gastrectomy for benign and malignant diseases: a single institute’s prospective analysis. J Am Coll Surg 2005; 200:191–197.PubMedCrossRefGoogle Scholar
  8. 8.
    Singh KK, Rohatgi A, Rybinkina I, McCulloch P, Mudan S. Laparoscopic gastrectomy for gastric cancer: early experience among the elderly. Surg Endosc 2008; 22:1002–1007.PubMedCrossRefGoogle Scholar
  9. 9.
    Lee WJ, Wang W, Chen TC, Chen JC, Ser KH. Totally laparoscopic radical BII gastrectomy for the treatment of gastric cancer: a comparison with open surgery. Surg Laparosc Endosc Percutan Tech 2008; 18:369–374.PubMedCrossRefGoogle Scholar
  10. 10.
    Wong SK, Tsui DK, Li MK. Laparoscopic distal gastrectomy for gastric cancer: initial experience on hand-assisted technique and totally laparoscopic technique. Surg Laparosc Endosc Percutan Tech 2009; 19:298–304.PubMedCrossRefGoogle Scholar
  11. 11.
    Bouras G, Lee SW, Nomura E, Tokuhara T, Nitta T, Yoshinaka R, Tsunemi S, Tanigawa N. Surgical outcomes from laparoscopic distal gastrectomy and Roux-en-Y reconstruction: evolution in a totally intracorporeal technique. Surg Laparosc Endosc Percutan Tech 2011; 21:37–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C. Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg 2007; 194:839–844; discussion 844.PubMedCrossRefGoogle Scholar
  13. 13.
    Du J, Zheng J, Li Y, Li J, Ji G, Dong G, Yang Z, Wang W, Gao Z. Laparoscopy-assisted total gastrectomy with extended lymph node resection for advanced gastric cancer—reports of 82 cases. Hepatogastroenterology 2010; 57:1589–1594.PubMedGoogle Scholar
  14. 14.
    Du J, Li J, Li Y, Ji G, Yang Z, Gao Z, Zheng J: Laparoscopically-assisted palliative total gastrectomy in patients with stage IV or metastatic gastric cancer: is it worthwhile? Hepatogastroenterology 2008; 55:1908–1912.PubMedGoogle Scholar
  15. 15.
    Shuang J, Qi S, Zheng J, Zhao Q, Li J, Kang Z, Hua J, Du J. A case–control study of laparoscopy-assisted and open distal gastrectomy for advanced gastric cancer. J Gastrointest Surg 2011; 15:57–62.PubMedCrossRefGoogle Scholar
  16. 16.
    Kawamura H, Yokota R, Homma S, Kondo Y. Comparison of invasiveness between laparoscopy-assisted total gastrectomy and open total gastrectomy. World J Surg 2009; 33:2389–2395.PubMedCrossRefGoogle Scholar
  17. 17.
    Ballesta-Lopez C, Poves I, Cabrera M, Almeida JA, Macias G. Learning curve for laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomosis: analysis of first 600 consecutive patients. Surg Endosc 2005; 19:519–524.PubMedCrossRefGoogle Scholar
  18. 18.
    Kinoshita T, Oshiro T, Ito K, Shibasaki H, Okazumi S, Katoh R. Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy. Surg Endosc 2010; 24:2908–2912.PubMedCrossRefGoogle Scholar
  19. 19.
    Ruiz-de-Adana JC, Lopez-Herrero J, Hernandez-Matias A, Colao-Garcia L, Muros-Bayo JM, Bertomeu-Garcia A, Limones-Esteban M. Laparoscopic hand-sewn gastrojejunal anastomoses. Obes Surg 2008; 18:1074–1076.PubMedCrossRefGoogle Scholar
  20. 20.
    Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nakahara M, Toshirou N. A simple and safe method for gastrojejunostomy in laparoscopic distal gastrectomy using the hemidouble-stapling technique: efficient purse-string stapling technique. Dig Surg 2009; 26:441–445.PubMedCrossRefGoogle Scholar
  21. 21.
    Noshiro H, Ohuchida K, Kawamoto M, Ishikawa M, Uchiyama A, Shimizu S, Tanaka M. Intraabdominal Roux-en-Y reconstruction with a novel stapling technique after laparoscopic distal gastrectomy. Gastric Cancer 2009; 12:164–169.PubMedCrossRefGoogle Scholar
  22. 22.
    Strong VE, Devaud N, Allen PJ, Gonen M, Brennan MF, Coit D. Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: a case–control study. Ann Surg Oncol 2009; 16:1507–1513.PubMedCrossRefGoogle Scholar
  23. 23.
    Scatizzi M, Kroning KC, Lenzi E, Moraldi L, Cantafio S, Feroci F. Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a case–control study. Updates Surg 2011; 63:17–23.PubMedCrossRefGoogle Scholar
  24. 24.
    Choi YY, Kim YJ. Intracorporeal anastomosis using a Lapra-ty clip in laparoscopic distal gastrectomy: initial clinical experiences. J Laparoendosc Adv Surg Tech A 2011; 21:51–55.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Jianjun Du
    • 1
  • Jianbo Shuang
    • 1
  • Jipeng Li
    • 1
  • Qingchuan Zhao
    • 1
  • Liu Hong
    • 1
  • Xiongwei Du
    • 1
  • Jiazhi Wen
    • 1
  • Jin Hua
    • 1
  1. 1.Department of Surgery, Xijing Hospital of Digestive DiseasesThe Fourth Military Medical UniversityXianChina

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