Abstract:Background: Laparoscopic distal gastrectomy (LDG) for gastric cancer has gradually gained popularity. However, the long-term oncological outcomes of LDG have rarely been reported. This study aimed to investigate the survival outcomes of LDG, and evaluate the early surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG).
“…In laparoscopic gastrectomy, laparoscopy assisted distal gastrectomy (LADG) is currently preferred to TLDG [ 17 ]. Although TLDG is being used presently, it is challenging due to the difficulty of performing an intracorporeal anastomosis [ 10 ].…”
PurposeThis study presents findings on the clinical usefulness of an overlap method that is another modification for the currently well-known intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG).MethodsWe studied 42 patients diagnosed with gastric cancer who underwent TLDG between December 2011 and March 2013. Endoscopic linear staplers were used for intracorporeal anastomosis and patients were observed with endoscopic tracking six months after surgery. We retrospectively reviewed the outcome of the operation, the clinical pathological results, and the endoscopy results.ResultsThe mean duration of the operation for 42 patients was 228.3 ± 42.5 minutes and the mean time to complete the anastomosis was 12.18 ± 2.3 minutes. There were no mortalities and no cases of open conversion. Following the operation, 37 patients had stage IA, 5 in stage IB, and 3 in stage II gastric cancer. Abscesses were seen in 3 patients and 5 cases of stasis during the postoperative period. Duodenoscopy 6 months after the operation showed 11 cases of gastric stasis, 28 cases of bile reflux, and 1 new case of erosive gastritis. We did not observe contraction in any of the patients.ConclusionThe overlap method for intracorporeal gastroduodenostomy, using an endoscopic linear stapler, can be considered a feasible and safe technique for the treatment of stomach cancer. However, a long-term comparative study is required to sufficiently evaluate our findings.
“…In laparoscopic gastrectomy, laparoscopy assisted distal gastrectomy (LADG) is currently preferred to TLDG [ 17 ]. Although TLDG is being used presently, it is challenging due to the difficulty of performing an intracorporeal anastomosis [ 10 ].…”
PurposeThis study presents findings on the clinical usefulness of an overlap method that is another modification for the currently well-known intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG).MethodsWe studied 42 patients diagnosed with gastric cancer who underwent TLDG between December 2011 and March 2013. Endoscopic linear staplers were used for intracorporeal anastomosis and patients were observed with endoscopic tracking six months after surgery. We retrospectively reviewed the outcome of the operation, the clinical pathological results, and the endoscopy results.ResultsThe mean duration of the operation for 42 patients was 228.3 ± 42.5 minutes and the mean time to complete the anastomosis was 12.18 ± 2.3 minutes. There were no mortalities and no cases of open conversion. Following the operation, 37 patients had stage IA, 5 in stage IB, and 3 in stage II gastric cancer. Abscesses were seen in 3 patients and 5 cases of stasis during the postoperative period. Duodenoscopy 6 months after the operation showed 11 cases of gastric stasis, 28 cases of bile reflux, and 1 new case of erosive gastritis. We did not observe contraction in any of the patients.ConclusionThe overlap method for intracorporeal gastroduodenostomy, using an endoscopic linear stapler, can be considered a feasible and safe technique for the treatment of stomach cancer. However, a long-term comparative study is required to sufficiently evaluate our findings.
BackgroundTotally laparoscopic gastrectomy (TLG) using intracorporeal anastomosis has gradually become mature thanks to the advancements of laparoscopic surgical instruments and the accumulation of operative experience. The goal of this study is to review our institution’s experience with TLG for the treatment of gastric cancer.MethodsA retrospective study was conducted to examine the short-term outcomes of TLG using intracorporeally stapler or hand-sewn anastomosis performed at Sir Run Run Shaw Hospital between March 2007 and June 2015. The details of intracorporeal anastomosis were described, and the clinicopathological data, surgical outcomes, and postoperative complications were evaluated.ResultsFour hundred seventy-eight patients were included in the study. Generally speaking, the patients could be divided into stapler or hand-sewn groups according to whether intracorporeal anastomosis was performed by only hand-sewn technique (n = 97) or only stapling devices (n = 381). For overall patients, the mean operation time and anastomotic time were 225.7 and 30.0 min, respectively. Postoperative complications were observed in 65 patients. All of the patients recovered well without perioperative death by conservative or surgical management.ConclusionsTLG using intracorporeally stapler or hand-sewn anastomosis is a reasonable option for the treatment of gastric cancer, with early data showing acceptable perioperative outcomes.
“…Traditionally, LADG is usually performed with a circular stapler or hand-sewing through a mini-laparotomy. LADG is currently preferred to TLDG in laparoscopic gastrectomy [16].…”
Background: Totally laparoscopic distal gastrectomy (TLDG) is a minimally invasive method for gastric cancer. Intracorporeal reconstruction of the digestive tract with technically challenging is a critical step. Objective: This study aimed to evaluate the feasibility and efficacy of a simplified method using a unidirectional barbed suture to create a continuous hand-sewn for gastrointestinal enterotomy closure and reinforcement of the duodenal stump (RDS) in our institutional experience. Methods: From March 2019 to December 2019, 32 patients who underwent TLDG with a hand-sewn gastrojejunostomy (GJA), jejunojejunostomy (JJ) and reinforcement the duodenal stump (RDS) were enrolled in this study. After tumor resection, the technique with the knotless unidirectional barbed suture was used to close the common incision for the linear stapler during the intracorporeal reconstruction following the TLDG. Patient characteristics, operative time, length of hospital stay, the time of the first flatus, and postoperative complications were evaluated. Results: The reinforcement and closure method were successfully performed after TLDG in the 32 patients without re-exploration. No major adverse events occurred during or after the operation. The mean procedure time was (247.3 ± 44.2) min, while the common incision closure procedure took a mean of 9.5±1.6min, the Laparoscopic Reinforcement Suture (LRS) procedure took a mean of 5.7± 0.9min, the blood loss was (68.0 ± 48.3) ml. The mean number of LNs dissected was (31.5 ± 11.3), the mean time of the first flatus was (3.7±1.2) days, the postoperative bed activity time (1.7±0.3)days, and the mean postoperative hospital stay was(9.5±2.7)days. The complications rate was 6.3%, including one emptying dysfunction, and one local abscess near duodenal stumps. Conclusions: The use of the unidirectional absorbable barbed suture for gastrojejunal/ jejunojejunal enterotomy closure and reinforcement of the duodenal stump is safe and effective in TLDG.
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