• Daisuke Ichikawa, Takeshi Kubota, Shojiro Kikuchi, Hitoshi Fujiwara, Masayoshi Nakanishi, Hisashi Ikoma, Kazuma Okamoto, Chohei Sakakura, Toshiya Ochiai, Yukihito Kokuba, and Eigo Otsuji.
• Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. ichikawa@koto.kpu-m.ac.jp
• Surg Laparosc Endosc Percutan Tech. 2009 Oct 1; 19 (5): e163-6.

BackgroundLaparoscopy-assisted distal gastrectomy (LADG) has recently been accepted as a preferred surgical procedure for patient with early gastric cancer. The Billroth-I method has been performed widely because of physiologic advantages and technical simplicity.MethodsSince September 2007, we performed standardized LADG for 35 patients with early gastric cancer. Of these 35 patients, 27 patients were reconstructed by Billroth-I anastomosis. Gastroduodenostomy was performed under direct vision for 11 patients (extracorporeal) and remaining 16 patients were anastomosed under laparoscopic vision facilitated by abdominal wall lifting with a right angle retractor (intracorporeal).ResultsThe mean duration of the anastomosis procedure was 17 and 20 minutes in extracorporeal and intracorporeal patients, respectively. The abdominal lifting method with a right angle retractor provided a good visual field without reestablishing pneumoperitoneum. The laparoscopic fine view could prevent surrounding fatty tissues and organs from intervening between the anastomosis planes and consequently guided an accurate and safe anastomosis. Neither anastomotic-related nor pancreatic-related complication was observed in this series.ConclusionsThis anastomotic technique should be useful as an easy and safe reconstruction method in LADG and is especially recommendable for less-experienced laparoscopic gastric surgeons.

22 keywords...

hide…