title: Surgical outcomes from laparoscopic distal gastrectomy and Roux-en-Y reconstruction: evolution in a totally intracorporeal technique.
abstract: BACKGROUND
  Laparoscopic gastrectomy is gaining popularity. Increasingly, Roux-en-Y reconstruction after distal gastrectomy is preferred because of reduced reflux and associated symptoms. Therefore, efficient and reliable techniques for intracorporeal Roux-en-Y reconstruction are in demand.
  
  
  OBJECTIVE
  To determine the surgical outcomes from laparoscopic distal gastrectomy and Roux-en-Y reconstruction in the treatment of gastric cancer.
  
  
  METHODS
  Laparoscopic gastrectomy is indicated for gastric cancer up to stage T1N1. Our technique for laparoscopic Roux-en-Y reconstruction incorporates intracorporeal-stapled gastrojejunostomy with extracorporeal hand-sewn jejunojejunostomy, or more recently, totally intracorporeal reconstruction.
  
  
  RESULTS
  From 2003 to 2009, 82 patients underwent laparoscopic distal gastrectomy with Roux-en-Y reconstruction. The mean age of the patients was 64.6 years (range, 39 to 83 y) and the male:female ratio was 2.4:1. Most patients (85%) had stage I disease. The mean operation time was 354 minutes (SD 82.7). The conversion rate was 0%. The mean lymph node yield was 27.2 nodes (SD 12.4). Eleven patients had totally intracorporeal reconstruction. Overall, anastomotic leakage of the gastrojejunostomy occurred in 2 patients (2.4%) both requiring reoperation. There were 2 cases (2.4%) of duodenal stump leakage, which were treated conservatively. Postoperative stasis was encountered in 2 patients (2.4%). The mean follow-up was 21 months (range, 5 to 50 mo). None of the patients developed reflux symptoms or endoscopic evidence of reflux during follow-up. Recurrence occurred in 1 patient who was the only patient with metastasis to the third tier of lymph nodes.
  
  
  CONCLUSIONS
  Surgical outcomes from laparoscopic distal gastrectomy and Roux-en-Y reconstruction were acceptable in the context of early gastric cancer. Totally intracorporeal reconstruction was technically feasible, safe, and associated with no obvious drawbacks.
authors.affiliation: Department of General and Gastrointestinal Surgery, Osaka Medical College, Japan. georgebouras@hotmail.com
authors.forename: George
authors.initials: G
authors.lastname: Bouras
authors.forename: Sang-Woong
authors.initials: SW
authors.lastname: Lee
authors.forename: Eiji
authors.initials: E
authors.lastname: Nomura
authors.forename: Takaya
authors.initials: T
authors.lastname: Tokuhara
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Nitta
authors.forename: Ryoji
authors.initials: R
authors.lastname: Yoshinaka
authors.forename: Soichiro
authors.initials: S
authors.lastname: Tsunemi
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Tanigawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000379:methods / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000706:statistics & numerical data*; D015390:Gastric Bypass / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome