• Yoshinori Hosoya, Alan Lefor, Masanobu Hyodo, Toru Zuiki, Hidenori Haruta, Kentaro Kurashina, Shin Saito, and Yoshikazu Yasuda.
• Department of Surgery, Jichi Medical University, Tochigi, Japan. hosoyo@jichi.ac.jp
• Hepato Gastroenterol. 2009 Sep 1;56(94-95):1571-5.

Background/AimsLaparoscopic-assisted distal gastrectomy (LADG) is a minimally invasive procedure for patients with gastric carcinoma. We have previously reported gasless LADG with a Billroth-I reconstruction using a 5-7cm minilaparotomy. We modified the technique for gasless LADG to include a Roux-en Y reconstruction and to expand the indications for its use.MethodologyA total of 40 patients with early stage gastric tumors (T1 n=38, T2 n=2) underwent this procedure. Following gasless laparoscopic distal gastrectomy with lymph node dissection, a jejunum to greater curvature of the gastric remnant anastomosis was performed using an intracorporeal laparoscopic stapled method. The jejuno-jejunal anastomosis was performed using a hand-sewn technique under direct vision through a mini-laparotomy.ResultsThe mean surgical time (n=40) was 222 min, estimated blood loss 101 ml, and the mean number of lymph nodes harvested was 21. There were no postoperative complications such as bleeding, leak, or cardio-pulmonary dysfunction. Mean body weight loss was 3.9 kg, and there is no evidence of recurrence during a mean followup of 14 months.ConclusionsGasless LADG with Roux-en-Y reconstruction is a feasible, novel procedure for a minimally invasive approach to gastric cancer.

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