title: A secure technique of intracorporeal Roux-Y reconstruction after laparoscopic distal gastrectomy.
abstract: BACKGROUND
  Laparoscopic distal gastrectomy [LDG] is a minimally invasive surgery for gastric carcinoma. The Billroth I method has been commonly employed to reconstruct alimentary tract after LDG. Conversely, Roux-Y reconstruction is employed far less commonly despite its merits. Technical difficulties, including a risk of twisting the Roux loop under limited vision through a laparoscope, have hampered Roux-Y reconstruction after LDG.
  
  
  METHODS
  We performed LDG and intracorporeal Roux-Y reconstruction in 5 patients with early gastric cancer. The procedure included a functional end-to-end anastmosis of the stomach and jejunum, consisting of side-to-side approximation of jejunal loop to greater curvature of the gastric remnant with a laparoscopic stapling device followed by closure of the open end and simultaneous division of the jejunum with another stapler.
  
  
  RESULTS
  Roux-Y reconstruction was successfully accomplished without torsion of the loop in all patients.
  
  
  CONCLUSIONS
  By using the present technique, intracorporeal Roux-Y reconstruction after LDG can be accomplished without a risk of twisting the jejunal loop.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan. sur098@poh.osaka-med.ac.jp
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Takaori
authors.forename: Eiji
authors.initials: E
authors.lastname: Nomura
authors.forename: Hideaki
authors.initials: H
authors.lastname: Mabuchi
authors.forename: San-Woong
authors.initials: SW
authors.lastname: Lee
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Agui
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Miyamoto
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Hisashi
authors.initials: H
authors.lastname: Watanabe
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Tanigawa
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D013536:Suture Techniques