J Gastric Cancer.  2011 Dec;11(4):212-218.

Intracorporeal Anastomosis Using Linear Stapler in Laparoscopic Distal Gastrectomy: Comparison between Gastroduodenostomy and Gastrojejunostomy

• Lee HW
• Kim HI
• An JY
• Cheong JH
• Lee KY
• Hyung WJ
• Noh SH

Abstract

PURPOSE
Intracorporeal anastomosis during laparoscopic gastrectomy is becoming increasingly prevalent. However, selection of the anastomosis method after laparoscopic distal gastrectomy is equivocal because of a lack of technical feasibility and safety. We compared intracorporeal gastroduodenostomy with gastrojejunostomy using linear staplers to evaluate the technical feasibility and safety of intracorporeal anastomoses as well as its' minimally invasiveness.
MATERIALS AND METHODS
Retrospective analyses of a prospectively collected database for gastric cancer revealed 47 gastric cancer patients who underwent laparoscopic distal gastrectomy with either intracorporeal gastroduodenostomy or gastrojejunostomy from March 2011 to June 2011. Perioperative outcomes such as operation time, postoperative complication, and hospital stay were compared according to the type of anastomosis. Postoperative inflammatory response was also compared between the two groups using white blood cell count and high sensitivity C-reactive protein.
RESULTS
Among the 47 patients, 26 patients received gastroduodenostomy, whereas 21 patients received gastrojejunostomy without open conversion or additional mini-laparotomy incision. There was no difference in mean operation time, blood loss, and length of postoperative hospital stays. There was no statistically significant difference in postoperative complication or mortality between two groups. However, significantly more staplers were used for gastroduodenostomy than for gastrojejunostomy (n=6) than for gastroduodenostomy and (n=5).
CONCLUSIONS
Intracorporeal anastomosis during laparoscopic gastrectomy using linear stapler, either gastroduodenostomy or gastrojejunostomy, shows comparable and acceptable early postoperative outcomes and are safe and feasible. Therefore, surgeons may choose either anastomosis method as long as oncological safety is guaranteed.

Keyword

Laparoscopy; Gastrectomy; Billroth I operation; Billroth II operation

MeSH Terms

Gastrectomy
Gastric Bypass
Gastroenterostomy
Humans
Laparoscopy
Length of Stay
Leukocyte Count
Postoperative Complications
Prospective Studies
Retrospective Studies
Stomach Neoplasms

Figure

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  Fig. 1 Intracorpoeal gastroduodenostomy using linear staplers. (A) Intraoperative image showing resection of the duodenum. (B) Resection of the stomach. (C) Creation of entry hole along the edge of the greater of the remnant stomach. (D) Creation of entry hole at medial end of the duodenum. (E) A linear stapler is placed in between the remnant stomach and the duodenum and fired. (F) First firing of a linear stapler to close the common entry hole. (G) Second firing of a linear stapler to close the common entry hole. (H) Stapler line of anastomosis aft er reconstruction.

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  Fig. 2 Intracorporeal gastrojejunostomy using linear staplers. (A) Intraoperative image showing resection of the duodenum. (B) Resection of the stomach and stapler line of artificial lesser curvature. (C) Creation of entry hole on the antimesenteric border of the jejunum. (D) Creation of entry hole on the greater curvature side of the remnant stomach. (E) A linear stapler is placed in between the remnant stomach and the jejunum. (F) Closure of the common entry hole using a linear stapler. (G) Anterior stapler line of the anastomosis. (H) Posterior stapler line of the anastomosis.

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  Fig. 3 (A) Changes of high sensitivity C-reactive protein aft er laparoscopic distal gastrectomy with intracorporeal gastroduodenostomy or gastrojejunostomy. There was no statistical diff erence between the anastomosis methods (Mixed model analysis, P=0.501). (B) Changes of white blood cell count aft er laparoscopic distal gastrectomy with intracorporeal gastroduodenostomy or gastrojejunostomy. There was no statistical diff erence between the anastomosis methods (Mixed model analysis, P=0.864). Preop = preoperative; postop = postoperative; POD = postoperative day.

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