J Gastric Cancer.  2010 Jun;10(2):69-74.

Linear-Shaped Gastroduodenostomy in Totally Laparoscopic Distal Gastrectomy

• Song HM
• Lee SL
• Hur H
• Cho YK
• Han SU

Abstract

PURPOSE
Laparoscopic gastrectomy has been common treatment modality for gastric cancer. But, most surgeons tend to perform laparoscopy-assisted distal gastrectomy using epigastric incision. Delta-shaped anastomosis is known as intracorporeal gastroduodenostomy, but it is technically difficult and needed many staplers. So we tried to find simple and economical method, here we report on the results of liner-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 25 patients who underwent totally laparoscopic distal gastrectomy using liner-shaped anastomosis at School of Medicine, Ajou University between January to October 2009. The indication was early gastric cancer as diagnosed by preoperative workup, the anastomoses were performed by using laparoscopic linear stapler.
RESULTS
There were 12 female and 13 male patients with a mean age of 55.6+/-11.2. The following procedures were performed 14 laparoscopic gastrectomies, 11 robotic gastrectomies. The mean operation time was 179.5+/-27.4 minutes, the mean anastomotic time was 17.5+/-3.4 minutes. The mean number of stapler cartridges was 5.6+/-0.8. Postoperative complication occurred in one patient, anastomotic stenosis, and the patient required reoperation to gastrojejunostomy. The mean length of postoperative hospital stay was 6.7+/-1.0 days except the complication case, and there was no case of conversion to open procedure and postoperative mortality.
CONCLUSIONS
Linear-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy is technically simple and feasible method.

Keyword

Laparoscopic distal gastrectomy; Gastroenterostomy; Linear stapler

MeSH Terms

Constriction, Pathologic
Female
Gastrectomy
Gastric Bypass
Gastroenterostomy
Humans
Length of Stay
Male
Medical Records
Postoperative Complications
Reoperation
Retrospective Studies
Stomach Neoplasms

Figure

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  Fig. 1 Localization of the location of the tumor. (A) After clipping with endoscopy, preoperative abdomen X-ray was performed. (B) After clipping on the greater curvature and the lesser curvature with endocilp, intraoperative abdomen X-ray was performed to decide resection line (black arrow = clipping on the lesser curvature; white arrow : clipping on the greater curvature).

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  Fig. 2 Trochar placement and the size of the trochars.

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  Fig. 3 Intraoperative view for preparing the anastomosis. (A) A small hole was made on the superior edge of duodenal staple line. (D = duodenum) (B) A small hole was made on the greater curvature of remnant stomach, 7 cm proximal to gastric staple line (RS = remnant stomach; arrow head=staple line).

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  Fig. 4 Intraoperative view for linear-shaped gastroduodenostomy. (A) As the linear stapler was inserted into the holes and fired, gastroduodenostomy was performed. (B) The entry hole was closed by a liner stapler. (C) After completion of intracorporeal B-I anastomosis, the closed entry hole is parallel to gastro-duodenostomy. RS = remnant stomach; D = duodenum.

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  Fig. 5 (A) Postoperative wound (B) F/u endoscopy after 6 months.

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