Abstract
BackgroundTotally laparoscopic distal gastrectomy (TLDG) using intracorporeal anastomosis has gradually developed due to advancements in laparoscopic surgical instruments. However, totally laparoscopic total gastrectomy (TLTG) with intracorporeal esophagojejunostomy (IE) is still uncommon because of technical difficulties. Herein, we evaluated various types of IE after TLTG in terms of the technical aspects. We compared the short-term operative outcomes between TLTG with IE and laparoscopy-assisted total gastrectomy (LATG) with extracorporeal esophagojejunostomy (EE).MethodsBetween March 2006 and December 2014, a total of 213 patients with gastric cancer underwent TLTG and LATG. Overall, 92 patients underwent TLTG with IE, and 121 patients underwent LATG with EE. Generally, there are two methods of IE: mechanical staplers (circular or linear staplers) and hand-sewn sutures. Surgical efficiencies and outcomes were compared between two groups. We also described various types of IE using a subgroup analysis.ResultsThe mean operation times were similar in the two groups, as was the number of retrieved lymph nodes. However, the mean estimated blood loss of TLTG was statistically lower than LATG. There were no significant differences in time to first flatus, the time to restart oral intake, the length of the hospital stay after operation, and postoperative complications. Four types of IE have been applied after TLTG, including 42 cases of hand-sewn IE. The overall mean operation time and the mean anastomotic time in TLTG were 279.5 ± 38.4 min and 52.6 ± 18.9 min respectively. There was no case of conversion to open procedure. Postoperative complication occurred in 16 patients (17.4 %) and no postoperative mortality occurred.ConclusionsIE is a feasible procedure and can be safely performed for TLTG with the proper laparoscopic expertise. It is technically feasible to perform hand-sewn IE after TLTG, which can reduce the cost of the laparoscopic procedure.
Highlights
Laparoscopic distal gastrectomy (TLDG) using intracorporeal anastomosis has gradually developed due to advancements in laparoscopic surgical instruments
Since the introduction of laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer in 1994 [3], LADG has become widely used for tumors located in the lower stomach with satisfactory surgical outcomes
We have reported that totally laparoscopic distal gastrectomy (TLDG) with intracorporeal reconstruction is better than laparoscopy-assisted distal gastrectomy (LADG) with extracorporeal reconstruction as it has improved outcomes such as better cosmesis, earlier bowel movements, less pain, and shorter hospital stays [7, 8]
Summary
Laparoscopic distal gastrectomy (TLDG) using intracorporeal anastomosis has gradually developed due to advancements in laparoscopic surgical instruments. We have reported that totally laparoscopic distal gastrectomy (TLDG) with intracorporeal reconstruction is better than laparoscopy-assisted distal gastrectomy (LADG) with extracorporeal reconstruction as it has improved outcomes such as better cosmesis, earlier bowel movements, less pain, and shorter hospital stays [7, 8] These advantages are attributed to the less invasiveness of totally laparoscopic surgery. We present our experiences and short-term clinical outcomes of TLTG with various types of IE using laparoscopic staplers or hand-sewn purse-string suture technique We compare those outcomes of patients with laparoscopy-assisted total gastrectomy (LATG) from our center to further clarify the safety and feasibility of IE
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