title: Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy.
abstract: BACKGROUND
  Laparoscopic gastrectomy has recently been gaining popularity as a treatment for cancer; however, little is known about the benefits of intracorporeal (IC) gastrointestinal anastomosis with pure laparoscopic distal gastrectomy (LDG) compared with extracorporeal (EC) anastomosis with laparoscopy-assisted distal gastrectomy (LADG).
  
  
  METHODS
  Between June 2000 and December 2011, we assessed 449 consecutive patients with early-stage gastric cancer who underwent LDG. The patients were classified into three groups according to the method of reconstruction LADG followed by EC hand-sewn anastomosis (LADG + EC) (n = 73), using any of three anastomosis methods (Billroth-I (B-I), Billroth-II (B-II) or Roux-en-Y (R-Y); LDG followed by IC B-I anastomosis (LDG + B-I) (n = 248); or LDG followed by IC R-Y anastomosis (LDG + R-Y) (n = 128)). The analyzed parameters included patient and tumor characteristics, operation details, and post-operative outcomes.
  
  
  RESULTS
  The tumor location was significantly more proximal in the LDG + R-Y group than in the LDG + B-I group (P < 0.01). Mean operation time, intra-operative blood loss, and the length of post-operative hospital stay were all shortest in the LDG + B-I group (P < 0.05). Regarding post-operative morbidities, anastomosis-related complications occurred significantly less frequently in with the LDG + B-I group than in the LADG + EC group (P < 0.01), whereas there were no differences in the other parameters of patients' characteristics.
  
  
  CONCLUSIONS
  Intracorporeal mechanical anastomosis by either the B-I or R-Y method following LDG has several advantages over at the LADG + EC, including small wound size, reduced invasiveness, and safe anastomosis. Although additional randomized control studies are warranted to confirm these findings, we consider that pure LDG is a useful technique for patients with early gastric cancer.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7, Daigaku-Machi, Takatsuki City Osaka 569-8686, Japan. sur079@poh.osaka-med.ac.jp
authors.forename: Sang-Woong
authors.initials: SW
authors.lastname: Lee
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Tanigawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Nomura
authors.forename: Takaya
authors.initials: T
authors.lastname: Tokuhara
authors.forename: Masaru
authors.initials: M
authors.lastname: Kawai
authors.forename: Kazutake
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Masako
authors.initials: M
authors.lastname: Hiramatsu
authors.forename: Junji
authors.initials: J
authors.lastname: Okuda
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome