Laparoscopic-assisted vagotomy and distal gastrectomy

Abstract

This is a report of the techniques used on and outcome for three patients who underwent laparoscopic-assisted vagotomy and distal gastrectomy for complicated peptic ulcer disease. The first patient had a Billroth I anastomosis in 2 h 42 min with an estimated blood loss of 200 ml. Oral fluids were started on day 3 and the diet progressed to a soft food by day 5. The patient was discharged 11 days after his gastrectomy following a transurethal prostatic resection on day 6. The second patient had a Billroth II anastomosis. The operation was completed in 4 h 40 min with an estimated blood loss of 350 ml. Oral fluids were commenced on the 1st postoperative day and the patient was tolerating a soft diet by day 4. The patient was discharged 5 days after his gastrectomy. The third patient had a Billroth I anastomosis with an estimated blood loss of less than 150 ml. The surgery took 2 h 35 min; the patient was tolerating oral fluids on the first postoperative day and was discharged on the 4th postoperative day on soft diet. Laparoscopic-assisted vagotomy and gastrectomy has the advantages of a minimal-access procedure without the risks of an intracorporeal anastomosis.

Early international results of laparoscopic gastrectomies

“…Indications for laparoscopic Billroth I gastrectomies are the same as for Billroth II gastrectomies. Technically, in most cases of Billroth I procedures, dissection and resection phases are carried out under the conditions of pneumoperitoneum, but the gastroduodenostomy is done by open technique through a small incision in the right upper quadrant [1,12]. Wedge resections can easily be performed with endostaplers and are mainly indicated in benign tumors of the stomach [9] and selected early gastric cancers [8].…”

“…Besides the totally intraperitoneal laparoscopic gastrectomy, laparoscopicassisted gastrectomy either by gasless technique (elevating the abdominal wall with U-shaped retractor) or insufflating the abdomen by CO 2 has been practiced by some authors [12]. The laparoscopic approach can now be extended to other related operations such as Billroth I gastrectomy, wedge resection, and total gastrectomy [1,7,10,[12][13][14].…”

Laparoscopically assisted gastric surgery using Dexterity Pneumo Sleeve

“…In addition, laparoscopic gastrectomy requires extension of the skin incision to retrieve the specimen. Based on several case reports, range of the wound size for specimen retrieval is from 25 mm to 50 mm [1,2,4,[6][7][8][9][11][12][13][14].…”

Laparoscopically assisted distal gastrectomy for early gastric cancer

“…Goh et al [1 I], Anvari et al [2], and Fowler et al [6] reported several cases of laparoscopic gastrectomy with favorable results, but all of these were for benign gastric ulcers. The first case of laparoscopically assisted Billroth I gastrectomy for early gastric cancer with lymph node dissection was reported by Kinato et al [16].…”