Progression from laparoscopic-assisted to totally laparoscopic distal gastrectomy: comparison of circular stapler (i-DST) and linear stapler (BBT) for intracorporeal anastomosis.
BACKGROUND
Billroth I (B-I) gastroduodenostomy is an anastomotic procedure that is widely performed after gastric resection for distal gastric cancer. A circular stapler often is used for B-I gastroduodenostomy in open and laparoscopic-assisted distal gastrectomy. Recently, totally laparoscopic distal gastrectomy (TLDG) has been considered less invasive than laparoscopic-assisted gastrectomy, and many institutions performing laparoscopic-assisted distal gastrectomy are trying to progress to TLDG without markedly changing the anastomosis method. The purpose of this report is to introduce the technical details of new methods of intracorporeal gastroduodenostomy using either a circular or linear stapler and to evaluate their technical feasibility and safety.


METHODS
Seventeen patients who underwent TLDG with the intracorporeal double-stapling technique using a circular stapler (n = 7) or the book-binding technique (BBT) using a linear stapler (n = 10) between February 2010 and April 2011 were enrolled in the study. Clinicopathological data, surgical data, and postoperative outcomes were analyzed.


RESULTS
There were no intraoperative complications or conversions to open surgery in any of the 17 patients. The usual postoperative complications following gastroduodenostomy, such as anastomotic leakage and stenosis, were not observed. Anastomosis took significantly longer to complete with DST (64 ± 24 min) than with BBT (34 ± 7 min), but more stapler cartridges were needed with BBT than with DST.


CONCLUSIONS
TLDG using a circular or linear stapler is feasible and safe to perform. DST will enable institutions performing laparoscopic-assisted distal gastrectomy with circular staplers to progress to TLDG without problems, and this progression may be more economical because fewer stapler cartridges are used during surgery. However, if an institution has already been performing δ anastomosis in TLDG but has been experiencing certain issues with δ anastomosis, converting from δ anastomosis to BBT should be beneficial.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. t-ikeda@surg2.med.kyushu-u.ac.jp
Tetsuo
T
Ikeda
Hiroyuki
H
Kawano
Yuichi
Y
Hisamatsu
Koji
K
Ando
Hiroshi
H
Saeki
Eiji
E
Oki
Takefumi
T
Ohga
Yoshihiro
Y
Kakeji
Shunichi
S
Tsujitani
Shunji
S
Kohnoe
Yoshihiko
Y
Maehara
D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D004385:Duodenostomy / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation / Q000379:methods*; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D061646:Operative Time; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods*