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Laparoscopic assisted distal gastrectomy with Billroth I reconstruction by using circular stapler

Nobuhiro Takiguchi, MD, PhD, Yoshihiro Nabeya, MD, PhD, Atsushi Ikeda, MD, PhD, Hiroaki Soda, MD, PhD, Toru Tonooka, MD, PhD, Isamu Hoshino, Toshiya Sakamoto, MD, Yousuke Iwadate, MD. Chiba Cancer Center

Objectives: Laparoscopic distal gastrectomy for early gastric cancer is a standard treatment in Japan described in guidelines. The surgical procedure has been shifting from laparoscopic assisted to complete laparoscopic surgery. In this study, we evaluated the outcomes and safety of the laparoscopic assisted distal gastrectomy.

Methods: For the marking of the oral side transecting line, the clipping at oral side of cancer lesion was performed by gastro-endoscopy before surgery. The lymph node dissection (D1 + / D2) is performed laparoscopically. As the dissection of the pancreatic superior region, the assistant hold the left gastric artery and keep the good view by retracting the pancreas. The common hepatic artery and proximal side of splenic artery are exposed. Both sides of the left gastric artery and vein are exposed. Left gastric vein and left gastric artery are cut after clipping and sealing. Lymph node dissention of hepato-duodenal ligament is done and right gastric artery is cut after clipping and sealing. Minor curvature of upper gastric wall is exposed (No1,3 dissection). Billroth I reconstruction by the Circular Stapler (CDH) is performed. Through the upper median incision with 5 cm, operator pulls out the stomach and transects the oral side of stomach with linear stapler after palpating the clips. Duodenum is transected after purse string suture. Gastroduodenal anastomosis is performed by CDH.

Results: Two hundred cases were analyzed. The operation time, blood loss and the conversion to open surgery rate were 175 minutes, 40 ml, and 1.0%, respectively. As postoperative complications, anastomotic failure, pancreatic fistula and postoperative bleeding were 2%, 1.5% and 1%, respectively. The reoperation rate was 2%. One surgical death due to cerebral infarction was experienced. There were no patients with pPM (pathological proximal margin) positive and too much PM distance. Frequency of abdominal wall incisional hernia and ileus were 1% and 0%, respectively.

Conclusion: Although there is the disadvantage that small laparotomy can be made in the upper abdomen, laparoscopic assisted distal gastrectomy with Billroth I reconstruction in our procedure is enough good from the viewpoint of the precision of proximal margin, and the incidence of serious complications.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 86405

Program Number: P693

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

60

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