Gastric residues in the remnant stomach after laparoscopy-Assisted distal gastrectomy for gastric cancer

Background: Food retention in the remnant stomach is known to be seen after distal gastrectomy. We have performed laparoscopy-assisted distal gastrectomy (LADG) with Billroth I reconstruction since March 1999, and have come by cases with significant amount of gastric residues which hinder regular endoscopic follow-ups. It seemed to be observed more often with LADG compared to conventional open distal gastrectomy (OG). Thus, we investigated the cause of this phenomenon, along with its effect on postoperative nutritional status. Patients and method: We retrospectively reviewed 77 patients who had undergone distal gastrectomy with Billroth I method for gastric cancer. We compared the surgical procedures and amount of gastric residues between the LADG and OG group. Correlation between the amount of gastric residues and postoperative nutritional status was also examined. Result: Forty-seven patients underwent LADG, and 30 underwent OG. Gastric residues were seen in 22 cases (47%) after LADG, and in 7 (23%) after OG, with statistically significant difference (P=0.04). Anastomosis were done using a circular stapler in all cases. In 6 cases of the LADG group, we used the cut end on the greater curvature of the remnant stomach for the anastomosis, whereas the posterior wall of the stomach in the rest of the group. In the OG group, the greater curvature was anastomotic site in 22 cases, and the posterior wall in 8. The size of the resected stomach was similar between the groups. Logistic regression analysis revealed that the laparoscopic approach was the only independent predictor for the gastric residues among the parameters including age, sex, anastomotic site and resection size. Postoperative changes in body weight and serum albumin level were similar between the patients with and without gastric residues. Conclusion: Postoperative gastric residue was seen more often with LADG compared to OG. We were unable to identify the essential cause of this phenomenon, but it seemed to have no effect on nutritional status after s

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Program Number: P277

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