J Gastric Cancer.  2013 Mar;13(1):34-43.

Comparison of Intracorporeal Reconstruction after Laparoscopic Distal Gastrectomy with Extracorporeal Reconstruction in the View of Learning Curve

• Ahn CW
• Hur H
• Han SU
• Cho YK

Abstract

PURPOSE
The intracorporeal reconstruction after laparoscopic gastrectomy can minimize postoperative pain, and give better cosmetic effect, while it may have technical difficulties and require the learning curve. This study aimed to analyze the surgical outcome of intracorporeal reconstruction according to the surgeon's experience comparing with extracorporeal procedure.
MATERIALS AND METHODS
From January 2009 to September 2011, intracorporeal reconstruction in laparoscopic surgery for gastric cancer was performed for 71 patients (Intra group). During same period, 231 patients underwent laparoscopy-assisted gastrectomy (Extra group). These patients were classified into initial (1st to 20th case of intra group), intermediate (21th to 46th case), and experienced (after 47th case) phases.
RESULTS
Intracorporeal procedures included 35 cases of Billroth-I, 30 Billroth-II and 6 Roux en Y reconstructions. In the initial phase, operation time (P=0.022) were significantly longer for the patients of intra group than them of extra group. Although the difference was not significant, the length of hospital stay was longer and complication rate was higher in the intra group. In intermediate and experienced phases, there was no difference between two groups in operation time and hospital stay. In these phases, complication rate was lower in the intra group than the extra group (3.9% versus 9.7%). The pain scale was significantly lower post operation day 5 in the intra group.
CONCLUSIONS
Intracorporeal reconstruction after laparoscopic distal gastrectomy was feasible and safe, and the technique was stabilized after 20th case if the surgeon has sufficient experiences when we compared it with extracorporeal reconstruction.

Keyword

Intracorporeal; Extracorporeal; Billorth I; Billroth II; Roux en Y

MeSH Terms

Cosmetics
Gastrectomy
Gastroenterostomy
Humans
Laparoscopy
Learning
Learning Curve
Length of Stay
Pain, Postoperative
Stomach Neoplasms
Cosmetics

Figure

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  Fig. 1 Localization of the location of the tumor. After clipping with endoscopy, preoperative abdomen X-ray was performed.

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  Fig. 2 Placement of surgical ports and wound for specimen delivery. For C, E, 12 mm ports are used. Two 5 mm ports are used for B, D, and flexible endoscope is introduced via port A. Port A are extended vertically for specimen delivery.

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  Fig. 3 Intracoporeal BI anastomosis (A, B, C), intracoporeal BII anastomosis (D, E, F), intracoporeal Roux en Y anastomosis (G, H, I). (A) Cut of duodenum upper edge. (B) Closure of endo GIA entry hole. (C) Laparoscopic view of the gastroduodenostomy. (D) Anastomosis with endo GIA. (E) Closure of endo GIA entry hole. (F) Laparoscopic view of the gastrojejunostomy. (G) Jejunojejunostomy with endo GIA. (H) Gastrojejunostomy with endo GIA. (I) Laparoscopic view of Roux en Y anastomosis.

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  Fig. 4 Change of postoperative pain scale after sugery. Each P-value was evaluated by student T-test. POD = post operation day.

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