Comparison of laparoscopy-assisted and total laparoscopic Billroth-I gastrectomy for gastric cancer: a report of short-term outcomes

Kinoshita, Takahiro; Shibasaki, Hidehito; Oshiro, Takashi; Ooshiro, Mitsuru; Okazumi, Shinichi; Katoh, Ryoji

doi:10.1007/s00464-010-1402-6

Cited by 95 publications

(82 citation statements)

References 21 publications

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“…We have developed a new, simple, and secure method of intracorporeal gastroduodenostomy, using only endoscopic linear staplers, which we have named the deltashaped anastomosis [1]. Because of its advantages, this procedure is gaining widespread acceptance among surgeons in Japan and Korea, where it is becoming a standard reconstruction procedure after laparoscopic distal gastrectomy [2][3][4][5]. In this report, we present the short-and longterm outcomes of our initial series of 100 consecutive procedures.…”

Section: Introductionmentioning

confidence: 99%

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

et al. 2011

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Background We developed a new method of intracorporeal gastroduodenostomy, the delta-shaped anastomosis, in which only endoscopic linear staplers are used. In this report, we present the short-and long-term outcomes of our initial experience with this procedure. Methods We retrospectively analyzed 100 consecutive gastric cancer patients who underwent the delta-shaped anastomosis procedure from May 2001 to November 2006. All of them underwent a laparoscopic distal gastrectomy with regional lymph node dissection. Quality of life was assessed with a questionnaire 6 months or more postoperatively, and the gastric remnant was evaluated by endoscopy one year following the surgery. Results Eight surgeons successfully performed the deltashaped anastomosis without any conversion to laparotomy. The learning curve for all surgeons was steep and the mean time for the anastomosis was 13 min. Only one patient developed an anastomotic leak, and the leak was minor. Sixty-five patients tolerated a 1500 kcal/day soft diet at the time of discharge. The mean follow-up period was 54.9 months. Only one patient reported symptoms indicative of dumping. Two patients were diagnosed with reflux esophagitis, and approximately 70% had evidence of bile reflux, but severe gastritis of the remnant stomach on endoscopy was uncommon. Conclusions The wide lumen of the delta-shaped anastomosis led to early, adequate postoperative oral intake without a significant incidence of dumping syndrome. The delta-shaped anastomosis is safe and simple and provides satisfactory postoperative results.

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Section: Introductionmentioning

confidence: 99%

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

et al. 2011

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“…With the development and introduction of sophisticated techniques for the construction of an intracorporeal anastomosis during laparoscopic gastrectomy, TLG has been increasingly performed worldwide [12,13]. Although it is essential to establish a method for the intraoperative localization of the tumor during TLG, especially for the early tumor located in the middle or upper region of the stomach, a simple and reliable procedure is still unavailable.…”

Section: Discussionmentioning

confidence: 99%

Simple and reliable method for tumor localization during totally laparoscopic gastrectomy: intraoperative laparoscopic ultrasonography combined with tattooing

et al. 2016

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We have developed a new method to localize a tumor during totally laparoscopic gastrectomy that uses intraoperative laparoscopic ultrasonography combined with preoperative clipping and tattooing. One or 2 days before the surgery, endoscopic clipping was performed just proximal to the tumor, followed by tattooing with India ink at the clipping site. Examination by intraoperative laparoscopic ultrasonography was performed at the tattooed site to detect the clips. The resection line of the stomach was determined with use of the detected clips as a marker of the proximal margin of the tumor. This method was attempted in 14 patients who underwent totally laparoscopic gastrectomy, and the clips were successfully identified in all patients. The clips were visualized as several layers of a hyperechoic bar, which was termed a ''ladder sign.'' The mean time from insertion of the laparoscopic probe to identification of the clips was 2 min. The ladder sign is an important finding in this method.

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“…Totally laparoscopic gastrectomy is less invasive and more comfortable for patients than laparoscopy-assisted gastrectomy (4,9). However, totally laparoscopic gastrectomy is not yet widely accepted, and its use is limited to just a few centers.…”

Section: Discussionmentioning

confidence: 99%

Totally laparoscopic D2 radical distal gastrectomy using Billroth II anastomosis: A case report

et al. 2016

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Abstract.Here, we present our first case of totally laparoscopic D2 radical distal gastrectomy using Billroth II anastomosis and evaluate its effectiveness in terms of minimal invasiveness, technical feasibility and safety for the resection of early gastric cancer. In the present case, only laparoscopic linear staplers were used for intracorporeal anastomosis. The time taken was 180 min, the anastomotic time was 15 min, the number of staples used was five, and the estimated blood loss was 30 ml. The first flatus was observed at 3 days, and a liquid diet was started at 6 days. The postoperative hospital stay was 8 days. No postoperative complications were noted with our case. In conclusion, totally laparoscopic Billroth II anastomosis using laparoscopic linear staplers for early gastric cancer is considered to be safe and feasible. IntroductionAs a minimally invasive surgical technique, laparoscopic radical gastrectomy is associated with advantages including reduced injury and postoperative pain, lower impact on immune function, milder morbidity and rapid recovery of gastrointestinal function with a short hospital stay (1-3). Laparoscopic gastrectomy is commonly performed in Taizhou Hospital, China, for the treatment of early and advanced gastric cancer. With the advances in technology and surgical techniques, totally laparoscopic distal gastrectomy may now be performed intra-abdominally using only endoscopic linear staplers. Totally laparoscopic distal gastrectomy has been defined as a method to intracorporeally perform resection and anastomosis using a laparoscopic technique (4-7). Totally laparoscopic distal gastrectomy has several advantages over laparoscopy-assisted distal gastrectomy, including reduced injury and a lower degree of invasiveness (4).Here, we present our initial experience with the first patient who underwent totally laparoscopic D2 radical distal gastrectomy using Billroth II anastomosis in our institution. We evaluated the effectiveness of totally laparoscopic D2 radical distal gastrectomy using Billroth II anastomosis in terms of minimal invasiveness, technical feasibility and safety for the resection of early gastric cancer. Case reportPatient. A 55-year-old male patient was admitted to our hospital due to upper abdominal discomfort accompanied with belching for three years. Gastroscopic biopsy confirmed the presence of adenocarcinoma of the gastric antrum (well differentiated). Abdominal computed tomography (CT) scan revealed the location of the gastric tumor (Fig. 1). No evidence of distant metastasis was observed during the preoperative abdominal CT scan. The preoperative tumor-node-metastasis (TNM) stage was cT2N0M0.Surgical procedure. Following the administration of general anesthesia, the patient was placed in the supine position with the head elevated and legs apart. During the surgery, five trocars were inserted. CO 2 pneumoperitoneum of 12 to 14 mmHg was established. Standing on the left side of the patient, the surgeon divided the stomach and duodenum using an ultrasonic scalpel ...

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Comparison of laparoscopy-assisted and total laparoscopic Billroth-I gastrectomy for gastric cancer: a report of short-term outcomes

Cited by 95 publications

References 21 publications

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

Simple and reliable method for tumor localization during totally laparoscopic gastrectomy: intraoperative laparoscopic ultrasonography combined with tattooing

Totally laparoscopic D2 radical distal gastrectomy using Billroth II anastomosis: A case report

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