Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience

Kim, Jin-Jo; Song, Kyo Young; Chin, Hyung Min; Kim, Wook; Jeon, Hae Myung; Park, Cho Hyun; Park, Seung Man

doi:10.1007/s00464-007-9446-y

Cited by 131 publications

(109 citation statements)

References 23 publications

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“…In the present study, however, the rate of anastomosis-related complications was lower than what has previously been reported [2,10], with only one patient experiencing a minor leakage, which responded to conservative management. Our experience with these 100 cases strongly suggests that the delta-shaped anastomosis is a simple and safe form of intracorporeal gastroduodenostomy.…”

Section: Discussioncontrasting

confidence: 91%

“…We have developed a new, simple, and secure method of intracorporeal gastroduodenostomy, using only endoscopic linear staplers, which we have named the deltashaped anastomosis [1]. Because of its advantages, this procedure is gaining widespread acceptance among surgeons in Japan and Korea, where it is becoming a standard reconstruction procedure after laparoscopic distal gastrectomy [2][3][4][5]. In this report, we present the short-and longterm outcomes of our initial series of 100 consecutive procedures.…”

Section: Introductionmentioning

confidence: 99%

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The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

et al. 2011

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Background We developed a new method of intracorporeal gastroduodenostomy, the delta-shaped anastomosis, in which only endoscopic linear staplers are used. In this report, we present the short-and long-term outcomes of our initial experience with this procedure. Methods We retrospectively analyzed 100 consecutive gastric cancer patients who underwent the delta-shaped anastomosis procedure from May 2001 to November 2006. All of them underwent a laparoscopic distal gastrectomy with regional lymph node dissection. Quality of life was assessed with a questionnaire 6 months or more postoperatively, and the gastric remnant was evaluated by endoscopy one year following the surgery. Results Eight surgeons successfully performed the deltashaped anastomosis without any conversion to laparotomy. The learning curve for all surgeons was steep and the mean time for the anastomosis was 13 min. Only one patient developed an anastomotic leak, and the leak was minor. Sixty-five patients tolerated a 1500 kcal/day soft diet at the time of discharge. The mean follow-up period was 54.9 months. Only one patient reported symptoms indicative of dumping. Two patients were diagnosed with reflux esophagitis, and approximately 70% had evidence of bile reflux, but severe gastritis of the remnant stomach on endoscopy was uncommon. Conclusions The wide lumen of the delta-shaped anastomosis led to early, adequate postoperative oral intake without a significant incidence of dumping syndrome. The delta-shaped anastomosis is safe and simple and provides satisfactory postoperative results.

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Section: Discussioncontrasting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

et al. 2011

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“…However, there have been few reports on TLG due to the difficulty of reconstruction [16]. We adopted the policy of TLG from the initial period of laparoscopic gastrectomy at our hospitals, and we have not experienced conversion to open surgery as a result of intracorporeal anastomosis.…”

Section: Discussionmentioning

confidence: 99%

“…In laparoscopy-assisted gastrectomy, extracorporeal anastomosis via mini-laparotomy incision may cause forceful tension and injuries to the structures around the anastomosis because of limited vision, particularly in obese patients [16]. In TLG, the whole anastomotic procedure can be clearly viewed, thereby eliminating such tension and injuries.…”

Section: Discussionmentioning

confidence: 99%

Totally laparoscopic gastrectomy for gastric cancer after endoscopic submucosal dissection: a propensity score matching analysis

Ebihara

Okushiba

Kurashima

et al. 2015

Langenbecks Arch Surg

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Results: Operative times for TLG in ESD group and non-ESD group were 228.2 ± 53.9 and 228.1 ± 52.7 min (P=0.989), and blood loss was 45.7 ± 83.0, 71.3 ± 74.5 g, respectively (P=0.161). There were no significant differences between the groups of ESD and non-ESD in postoperative recovery and postoperative complications. In totally laparoscopic distal gastrectomy (TLDG), the patients with ESD-resected specimens of more than 50 mm in diameter had significantly longer operative times (P=0.009).Conclusions: In this study, TLG is feasible procedure treatment of gastric cancer regardless of ESD. However, TLDG is more difficult in cases where the ESD-resected specimen is more than 50 mm in diameter.

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“…Several surgeons have also reported the safety and feasibility of the totally laparoscopic gastrectomy [13][14][15]. Compared with the laparoscopy-assisted procedure, the totally laparoscopic gastrectomy was found to be less invasive because it does not require a mini-laparotomy.…”

Section: Introductionmentioning

confidence: 99%

Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes

et al. 2014

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Introduction The feasibility, safety, and improved quality of postoperative life following laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with a hand-sewn anastomosis via a mini-laparotomy for early gastric cancer (EGC) have been previously established. Here we describe the surgical procedure of totally laparoscopic pylorus-preserving gastrectomy (TLPPG) using an intracorporeal delta-shaped anastomosis technique, and the short-term surgical outcomes of 60 patients with EGC in the middle stomach are reported. Methods After lymphadenectomy and mobilization of the stomach, intraoperative gastroscopy was performed in order to verify the location of the tumor, and then the distal and proximal transecting lines were established, 5 cm from the pyloric ring and just proximal to Demel's line, respectively. Following transection of the stomach, a deltashaped intracorporeal gastrogastrostomy was made with linear staplers. Results There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 259 min and 28 mL, respectively. Twelve patients (20.0 %) experienced postoperative complications classified as grade II using the Clavien-Dindo classification, with the most frequent complication being gastric stasis (6 cases, 10.0 %). The incidence of severe complications classified as grade III or above was 1.7 %; only one patient required reoperation and intensive care due to postoperative intraabdominal bleeding and subsequent multiple organ failure. Conclusion TLPPG with an intracorporeal delta-shaped anastomosis was found to be a safe procedure, although it tended to require a longer operating time than the wellestablished LAPPG with a hand-sewn gastrogastrostomy.

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Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience

Abstract: TLG with intracorporeal anastomosis using laparoscopic linear staplers was safe and feasible, and we were able to obtain acceptable surgical outcomes in terms of minimal invasiveness.

Cited by 131 publications

References 23 publications

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

Totally laparoscopic gastrectomy for gastric cancer after endoscopic submucosal dissection: a propensity score matching analysis

Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes

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