Laparoscopic billroth II distal subtotal gastrectomy with gastric stump suspension for gastric malignancies

Abstract

Laparoscopy has played an ill-defined role as a diagnostic tool for the staging of gastric and other intra-abdominal malignancies for a long time. The widespread use of the laparoscopic approach for the treatment of some benign abdominal diseases, such as biliary lithiasis and gastroesophageal reflux disease, has encouraged the authors toward its use in the treatment of malignant gastric neoplasms, both for palliation and for curative surgery. A five-puncture technique for laparoscopic distal subtotal gastrectomy, omentectomy, division of the left gastric artery at its origin, and D1 lymph node dissection has been developed by the authors, and is fully depicted and discussed. Reconstruction of digestive continuity is achieved through a posterior transmesocolic side-to-side stapled gastrojejunostomy, facilitated by an original method of suspension of the gastric stump to the anterior abdominal wall. In a preliminary series of 10 cases, this technique was demonstrated to be safe, showing no mortality, and having morbidity rates comparable to those of open surgery. The operation is effective, with a mean number of resected nodes comparable to that usually achieved in open surgery, and no cases of conversion to laparotomy.