title: A totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG) for improvement of the early surgical outcomes in high BMI patients.
abstract: OBJECTIVE
  To evaluate the effectiveness of totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG), we compared its early surgical outcomes with those of laparoscopy-assisted distal gastrectomy with gastroduodenostomy (LADG).
  
  
  METHODS
  We retrospectively analyzed early surgical outcomes in 567 patients who underwent laparoscopic gastrectomy for gastric cancer between January 2009 and March 2010. The patients were divided into those with underwent TLDG and those with underwent LADG. Their surgical outcomes were analyzed according to the WHO Asia-Pacific Obesity classification.
  
  
  RESULTS
  In overall patients, TLDG showed the significant results of early surgical outcomes. But more importantly, in the analysis of early surgical outcomes for obese patients, we found that TLDG could improve overall complication rate (p = 0.031), time to first flatus (p = 0.009), time to commencement of soft diet (p < 0.001), administration of analgesics (p = 0.019), pain score (Numeric Rating Scale, NRS), and hospital discharge (p = 0.003).
  
  
  CONCLUSIONS
  We suggested that TLDG contributes to the improvement of early surgical outcomes. We further suggest that TLDG in obese patients could be the best way to improve early surgical outcomes, including the bowel movement, pain score, overall complication rate, and hospital discharge.
authors.affiliation: Department of Gastric Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Min Gyu
authors.initials: MG
authors.lastname: Kim
authors.forename: Hironori
authors.initials: H
authors.lastname: Kawada
authors.forename: Beom Su
authors.initials: BS
authors.lastname: Kim
authors.forename: Tae Hwan
authors.initials: TH
authors.lastname: Kim
authors.forename: Kap Choong
authors.initials: KC
authors.lastname: Kim
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Yook
authors.forename: Byung Sik
authors.initials: BS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D020127:Recovery of Function; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D013851:Thinness / Q000150:complications; D016896:Treatment Outcome