Intracorporeal Billroth-I anastomosis using a circular stapler by the abdominal wall lifting method in laparoscopy-assisted distal gastrectomy.
BACKGROUND
Laparoscopy-assisted distal gastrectomy (LADG) has recently been accepted as a preferred surgical procedure for patient with early gastric cancer. The Billroth-I method has been performed widely because of physiologic advantages and technical simplicity.


METHODS
Since September 2007, we performed standardized LADG for 35 patients with early gastric cancer. Of these 35 patients, 27 patients were reconstructed by Billroth-I anastomosis. Gastroduodenostomy was performed under direct vision for 11 patients (extracorporeal) and remaining 16 patients were anastomosed under laparoscopic vision facilitated by abdominal wall lifting with a right angle retractor (intracorporeal).


RESULTS
The mean duration of the anastomosis procedure was 17 and 20 minutes in extracorporeal and intracorporeal patients, respectively. The abdominal lifting method with a right angle retractor provided a good visual field without reestablishing pneumoperitoneum. The laparoscopic fine view could prevent surrounding fatty tissues and organs from intervening between the anastomosis planes and consequently guided an accurate and safe anastomosis. Neither anastomotic-related nor pancreatic-related complication was observed in this series.


CONCLUSIONS
This anastomotic technique should be useful as an easy and safe reconstruction method in LADG and is especially recommendable for less-experienced laparoscopic gastric surgeons.
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. ichikawa@koto.kpu-m.ac.jp
Daisuke
D
Ichikawa
Takeshi
T
Kubota
Shojiro
S
Kikuchi
Hitoshi
H
Fujiwara
Masayoshi
M
Nakanishi
Hisashi
H
Ikoma
Kazuma
K
Okamoto
Chohei
C
Sakakura
Toshiya
T
Ochiai
Yukihito
Y
Kokuba
Eigo
E
Otsuji
D000005:Abdomen / Q000601:surgery*; D004385:Duodenostomy / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation / Q000379:methods*; D005763:Gastroenterostomy / Q000295:instrumentation / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods*