Background: Despite large worldwide experience, laparoscopic gastric surgery in the US has been slow to gain acceptance into clinical practice because of a relative paucity of gastric surgical cases in general. Below we review the results and outcomes of 30 laparoscopic gastric operations performed at a large community hospital.
Hypothesis: Laparoscopic gastric surgery for benign and malignant disease is safe and can achieve the same goals as open gastric surgery
Design: Retrospective analysis of prospectively collected clinical data
Patients and Methods: All patients were operated on by one surgical group (4 surgeons). Operative times, blood loss, length of stay, number of lymph nodes harvested, resection margins, morbidity, and 30-day mortality were used as outcome measures.
Results: A total of 30 patients (13 males, 17 females) were operated over a 40-month period. Indications included: GIST (3), adenocarcinoma (18), perforated duodenal ulcer (4), gastric outlet obstruction (1), nonhealing gastric ulcer (4). The following procedures were performed: for malignancy – gastrectomy (subtotal-10, total -1, proximal -3, esophagogastrectomy – 1), wedge resection (3), and palliative gastrojejunostomy (3); for benign disease – closure of the perforated ulcer (4), vagotomy/gastrojejunostomy (1), vagotomy/antrectomy (1), partial gastrectomy (2), and subtotal gastrectomy (1). There were 3 conversions. Mean operative time for gastrectomy was 260 + 64 min, mean blood loss was 240 + 168 cc. Mean number of lymph nodes harvested was 14.27 + 19. Margins were negative in all but one case of palliative gastrectomy. There was no mortality. Complications (4) included atrial fibrillation, delirium, pneumonia and wound infection. Mean length of stay was 9.62+4.6 days after operations for gastric malignancy vs. 5.25+1.5 days after procedures for benign disease (p< 0.05 Fisher’s exact test).
Conclusion: Laparoscopic gastric surgery for benign and malignant disease can be safely performed at a community hospital setting with acceptable operative times, blood loss, and minimal morbidity and no mortality.
Program Number: P245