Gasless laparoscopic distal gastrectomy with Roux-en-Y reconstruction.
OBJECTIVE
Laparoscopic-assisted distal gastrectomy (LADG) is a minimally invasive procedure for patients with gastric carcinoma. We have previously reported gasless LADG with a Billroth-I reconstruction using a 5-7cm minilaparotomy. We modified the technique for gasless LADG to include a Roux-en Y reconstruction and to expand the indications for its use.


METHODS
A total of 40 patients with early stage gastric tumors (T1 n=38, T2 n=2) underwent this procedure. Following gasless laparoscopic distal gastrectomy with lymph node dissection, a jejunum to greater curvature of the gastric remnant anastomosis was performed using an intracorporeal laparoscopic stapled method. The jejuno-jejunal anastomosis was performed using a hand-sewn technique under direct vision through a mini-laparotomy.


RESULTS
The mean surgical time (n=40) was 222 min, estimated blood loss 101 ml, and the mean number of lymph nodes harvested was 21. There were no postoperative complications such as bleeding, leak, or cardio-pulmonary dysfunction. Mean body weight loss was 3.9 kg, and there is no evidence of recurrence during a mean followup of 14 months.


CONCLUSIONS
Gasless LADG with Roux-en-Y reconstruction is a feasible, novel procedure for a minimally invasive approach to gastric cancer.
Hosoya
Yoshinori
Y
Department of Surgery, Jichi Medical University, Tochigi, Japan. hosoyo@jichi.ac.jp
Lefor
Alan
A
Hyodo
Masanobu
M
Zuiki
Toru
T
Haruta
Hidenori
H
Kurashina
Kentaro
K
Saito
Shin
S
Yasuda
Yoshikazu
Y
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged