Ann Surg Treat Res.  2015 Dec;89(6):306-312. 10.4174/astr.2015.89.6.306.

Modified intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: early experience

Affiliations
  • 1Department of Surgery, Chungnam National University Hospital, Daejeon, Korea. mr231@cnu.ac.kr

Abstract

PURPOSE
This study presents findings on the clinical usefulness of an overlap method that is another modification for the currently well-known intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG).
METHODS
We studied 42 patients diagnosed with gastric cancer who underwent TLDG between December 2011 and March 2013. Endoscopic linear staplers were used for intracorporeal anastomosis and patients were observed with endoscopic tracking six months after surgery. We retrospectively reviewed the outcome of the operation, the clinical pathological results, and the endoscopy results.
RESULTS
The mean duration of the operation for 42 patients was 228.3 +/- 42.5 minutes and the mean time to complete the anastomosis was 12.18 +/- 2.3 minutes. There were no mortalities and no cases of open conversion. Following the operation, 37 patients had stage IA, 5 in stage IB, and 3 in stage II gastric cancer. Abscesses were seen in 3 patients and 5 cases of stasis during the postoperative period. Duodenoscopy 6 months after the operation showed 11 cases of gastric stasis, 28 cases of bile reflux, and 1 new case of erosive gastritis. We did not observe contraction in any of the patients.
CONCLUSION
The overlap method for intracorporeal gastroduodenostomy, using an endoscopic linear stapler, can be considered a feasible and safe technique for the treatment of stomach cancer. However, a long-term comparative study is required to sufficiently evaluate our findings.

Keyword

Stomach neoplasms; Laparoscopy; Gastroduodenostomy

MeSH Terms

Abscess
Bile Reflux
Duodenoscopy
Endoscopy
Gastrectomy*
Gastritis
Gastroparesis
Humans
Laparoscopy
Mortality
Postoperative Period
Retrospective Studies
Stomach Neoplasms*

Figure

  • Fig. 1 Troca placement. Umbilical port (5 mm or 10 mm) is for a telescope, and left lower port is for endoscopic linear stapler and removal of the resected specimen. When the resected specimen is removed, left lower port is extended 3 cm.

  • Fig. 2 Schematic outline of the overlap method. (A) Distal gastrectomy and duodenectomy. Duodenal division is performed in 90 degree rotated state than conventional division. (B) Gastroduodenostomy done at greater curvature 6 cm apart from previous staple line of stomach and anterior pole of duodenum. (C) The remaining opening is closed with linear stapler.

  • Fig. 3 Intraoperative view for overlap method gastroduodenostomy. (A) Gastrectomy was done. (B) Remnant stomach and duodenum overlap. (C) After gastroduodenostomy. (D) Common incision was closed by linear stapler just like V shape. (E) After the anastomosis was completed.

  • Fig. 4 UGI series (gastrograffin) on 5 days after operations showed no anastomosis leakage and stricture and no delay passage of gastrograffin.

  • Fig. 5 Residue, gastritis, bile reflux classification according to endoscopic finding at 6 months (A) and at 18 months (B) after operation.

  • Fig. 6 Endoscopic findings at 6 months (A) and at 18 months (B) after operation. Anastomosis areas were wide enough without stenosis.


Cited by  1 articles

Modified Book Binding Technique (MBBT) for Intracorporeal Gastroduodenostomy in Totally Laparoscopic Distal Gastrectomy: Initial Experience
Jin Sung Kim, Eun Young Park, Dong Jin Park, Gyu Yeol Kim
J Gastric Cancer. 2019;19(3):355-364.    doi: 10.5230/jgc.2019.19.e30.


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