title: Previous laparotomy is not a contraindication to laparoscopy-assisted gastrectomy for early gastric cancer.
abstract: BACKGROUND
  Laparoscopic procedures have generally been considered to be contraindicated in patients with a history of laparotomy because of a high risk of enteric injury during the procedure. Laparoscopy-assisted gastrectomy (LAG) has been used increasingly in the treatment of early gastric cancer, but its indication for patients with a history of laparotomy remains unclear. The aim of the present study was to estimate whether LAG is contraindicated for the patient with a history of laparotomy (PSURG).
  
  
  METHODS
  From January 2003 to March 2006, 139 patients with early gastric cancer underwent LAG with curative intent in our institute. Fifty were PSURG patients, and the remaining 89 patients underwent LAG without any history of laparotomy (NSURG). Operative and early postoperative outcomes were compared between the groups.
  
  
  RESULTS
  Appendectomy and gynecological surgery were the predominant procedures performed in the PSURG group prior to undergoing LAG, involving 28 patients (56.0%) and 16 patients (32.0%), respectively. Detachment of adhesion above the umbilicus was required in 25 PSURG patients (50.0%). There was no significant difference in operative and postoperative results between the two groups, although 1 PSURG patient developed symptoms of bowel injury on the first postoperative day, probably caused during the laparoscopic procedure for dissection of a jejuno-jejunal adhesion.
  
  
  CONCLUSIONS
  There was no difference in outcome following LAG between the PSURG and NSURG groups in the present study. The PSURG patient is not contraindicated for LAG assuming careful attention is given for all operative procedures, including port insertion and dissection of intra-abdominal adhesions.
authors.affiliation: Department of Surgery, Cancer Institute Hospital, 10-6 Ariake 3-chome, Koto-ku, Tokyo 135-8550, Japan.
authors.forename: Souya
authors.initials: S
authors.lastname: Nunobe
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiki
authors.forename: Tetsu
authors.initials: T
authors.lastname: Fukunaga
authors.forename: Msanori
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Ohyama
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Seto
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D000075202:Contraindications; D005260:Female; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*