Evaluation of the cost for laparoscopic-assisted Billroth I gastrectomy

Adachi, Yosuke; Shiraishi, Norio; Ikebe, Kenshiro; Aramaki, Masanori; Bandoh, Toshio; Kitano, Seigo

doi:10.1007/s004640090089

Cited by 39 publications

(28 citation statements)

References 30 publications

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“…Goh et al [66] performed an international questionnaire-based study and reported that 10 of 16 surgeons surveyed considered LADG to be superior to ODG because of faster recovery, less pain, and better cosmesis. Adachi et al [67] compared the cost of LADG with that of ODG, and reported that LADG was less expensive than ODG because of the shorter hospital stay. …”

Section: Biological Response After Surgerymentioning

confidence: 99%

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

2006

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surgery, including less invasiveness, less pain, earlier recovery, and better cosmesis [2]. Kitano et al. [3] first applied and described laparoscopy-assisted distal gastrectomy (LADG) as treatment for early gastric cancer (EGC) in 1994.With the development of various diagnostic modalities and the spread of mass screening, EGC now accounts for more than 50% of the total incidence of gastric cancer in Japan. The low frequency of lymph node metastasis in patients with EGC is well known; it reportedly occurs in 2%-5% of those with mucosal cancer and 11%-20% of those with submucosal cancer [4]. To allow for the treatment of EGC in patients without a risk of lymph node metastasis, laparoscopic wedge resection (LWR) with a lesion-lifting method was developed by Ohgami et al. [5] in 1992, and intragastric mucosal resection (IGMR) was developed by Ohashi [6] in the early 1990s. With the recent development of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) [7], the use of LWR and IGMR seems to be decreasing, whereas the use of LADG with lymph node dissection has increased in patients with EGC with a risk of lymph node metastasis.The past 15 years have seen remarkable advances in laparoscopic surgical techniques and instruments, such as laparoscopic coagulating shears [8]. Extended lymph node dissection (D2) and total gastrectomy can now be performed laparoscopically [9,10]. However, LADG remains controversial as a standard surgery for gastric cancer because there are few studies evaluating the technical difficulty, advantages, and oncological feasibility of LADG.Here, we review reports, in the English-language literature, of LADG with lymph node dissection as treatment for cancer, to clarify the current status of this technique and related problems. AbstractSince 1991, laparoscopic surgery has been adopted for the treatment of gastric cancer, and it has been performed worldwide, especially in Japan and Korea. We reviewed the English-language literature to clarify the current status of and problems associated with laparoscopic gastrectomy with lymph node dissection as treatment for gastric cancer. In Japan, early-stage gastric cancer (T1/T2, N0) is considered the only indication for laparoscopic gastrectomy. As yet, there is little high-level evidence based on long-term outcome supporting laparoscopic gastrectomy for cancer, but reports have provided level 3 evidence that the procedure is technically safe, and that it yields better short-term outcomes than open surgery; that is, recovery is faster, hospital stay is shorter, there is less pain, and cosmesis is better. However, investigation into the oncological outcome of laparoscopic gastrectomy as treatment for cancer is lacking. To establish laparoscopic surgery as a standard treatment for gastric cancer, multicenter randomized controlled trials to compare the short-and longterm outcomes of laparoscopic surgery versus open surgery are necessary.

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Section: Biological Response After Surgerymentioning

confidence: 99%

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

2006

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“…The cost reduction strategy for LADG and LDG under the national health insurance system in Japan includes the use of inexpensive disposable or reusable instruments, limitation of the use of the energy device to only one, and reduction of the use of non-refundable disposable instruments [14]~ [16] and the choice of B-I instead of R-Y which needs more disposable instruments for the reconstruction.…”

Section: Discussionmentioning

confidence: 99%

The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan

Hoya¹

2017

ASS

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Abstract:The utility and problems including the socioeconomic aspect of laparoscopy-assisted (LADG) and laparoscopic distal gastrectomy (LDG) for gastric cancer has not been fully evaluated. We compared between open distal gastrectomy (ODG), LADG and LDG, the clinical benefit and quality of life by the reference documents. The problems of operation cost were derived by simulating the material used for each operation with Billroth I (B-I) reconstruction, and calculating the operation fee under the national health insurance system in Japan. The operation time of LADG and LDG was longer than that of ODG. However, the intraoperative blood loss of LADG and LDG was less and the postoperative hospital stay as well as the duration of fasting after LADG and LDG were shorter than those after ODG. The number of excised lymph nodes and the incidence of postoperative complications were comparable between LADG, LDG and ODG. On the other hand, in the national health insurance system, the operation fee of ODG was US$7187 as compared to US$8012 for LADG and US$7962 for LDG. In spite of the US$825 and US$775 difference in the operation fee, the use of disposable instruments for LADG and LDG results in the deficit of approximately US$650 and US$850 over ODG, respectively. In spite of the medical superiority of LADG and LDG over ODG as less invasive surgery, LADG and LDG in the current Japanese health insurance system are associated with less financial benefit to the hospital as compared to ODG.

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“…However, in recent years, anastomosis using automatic suturing instruments has been mainly used for Billroth-I intracorporeal anastomosis, including a square suturing method [13] developed by Tanimura et al [14] a hand-assisted method [14][15][16], an overlap method [4] developed by Uyama et al [3] and d anastomosis reported by Kanaya et al [2].The disadvantages of mechanical anastomosis are characterized by the fact that it is affected by the degrees of freedom of the duodenum and that many automatic suturing instruments (namely 3-6) are used. However, the anastomotic opening is large, the procedure is simple, and the duration of anastomosis is short.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, cosmetically, a small 3 cm incision in the umbilicus is sufficient for extracting the stomach. We have treated 18 cases at our hospital, and although time was required to perform handsewn gastroduodenal anastomosis in the early cases, it is believed that the surgery time can be reduced if the procedures for anastomosis are standardized [16][17][18]. We plan to study and report further cases in the future.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic distal gastrectomy with intracorporeal handsewn Billroth-I anastomosis (ICHSA)

et al. 2012

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Background The number of cases of laparoscopic surgery has been increasing. Lymph node dissection has been standardized, and the enlarged view provided by laparoscopes allows for the procedure to be performed successfully entirely within the abdominal cavity, but many cases of reconstruction using the Billroth-I method are performed under direct vision through a small incision. In this study, by placing an anchor thread on a suture line on the lesser curvature of the stomach, we simplified the procedure for handsewn anastomosis and safely performed gastroduodenal anastomosis at low cost to obtain good results. Methods From January 2009 to December 2010, we performed handsewn gastroduodenal anastomosis in 18 cases. After performing lymph node dissection, the duodenum and the stomach were separated using an automatic stapling device. Anchor sutures were placed on the suture line of the lesser curvature of the stomach. First, the seromuscular layer of the stomach and the seromuscular layer of the duodenum were sutured by performing interrupted suturing using an extracorporeal knot-tying method. With the stomach and the duodenum in a fixed state, the anastomosis area was opened. The thread of the anchor suture was pulled toward the abdominal wall, and then all layers of the stomach and the duodenum at the posterior wall were continuously sutured. Similarly, for the anterior wall, all layers were continuously sutured from the lesser curvature toward the greater curvature. Results We performed this anastomotic procedure in 18 patients with early gastric carcinoma. The mean time required for the anastomosis was 64.6 ± 17.1 min, and the estimated blood loss was 53.1 ± 91 g. All operations were curative, and the mean number of retrieved lymph node was 27.1 ± 10.8. A nasogastric tube was removed on the first or second day. An upper gastrointestinal series performed on postoperative days 5-6 showed no anastomotic leakage and normal transit. Oral intake was started on days 6-7. Postoperative complications included one case of a ruptured suture, but this was resolved through a conservative approach. There was no mortality. Postoperative endoscopy revealed that the anastomosis area was extremely soft, and no abnormalities were observed. Moreover, the only costs related to the anastomosis were for the thread and needles, and although more time was required compared with mechanical anastomosis, the cost was extremely low. Conclusions We performed gastroduodenal anastomosis under a total laparoscopic approach by handsewn. This method is economical, because it does not require the use of machinery for anastomosis, and the duodenal stump is short. We believe that this method, which can be performed in a similar manner even for obese patients, can be used as a standard method of anastomosis.

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Evaluation of the cost for laparoscopic-assisted Billroth I gastrectomy

Cited by 39 publications

References 30 publications

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

The Simulation of Operation Cost in Laparoscopy-Assisted and Laparoscopic Distal Gastrectomy Under the National Health Insurance System in Japan

Laparoscopic distal gastrectomy with intracorporeal handsewn Billroth-I anastomosis (ICHSA)

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