Laparoscopic Pylorus-preserving Gastrectomy With Intracorporeal Delta-shaped Anastomosis

Shinya Tanimura, PhD, Naoki Hiki, PhD, Soya Nunobe, PhD, Sayuri Sekikawa, Dr, Takehiro Chiba, Dr, Toshiyuki Kosuga, Dr, Takafumi Sato, Dr, Yoshikazu Hashimoto, Dr, Yohei Watanabe, Dr, Koshi Kumagai, Dr, Susumu Aiko, Dr, Takeshi Kubota, PhD, Takeshi Sano, PhD, Toshiharu Yamaguchi, PhD. Cancer Institute Hospital, Japan Foundation for Cancer Research


(Aim) Recently, pylorus-preserving gastrectomy has been recognized a safe and feasible procedure as an option of the treatment for early gastric cancer in the middle third of the stomach. On the other hand, laparoscopic gastrectomy followed by intracorporeal reconstruction of the digestive tract has become popular according to the advance of laparoscopic technique. Here, we present the procedure and the short-term outcomes of laparoscopic pylorus-preserving gastrectomy (LPPG) followed by intracorporeal anastomosis using linear staplers for early gastric cancer.
(Patients and Methods) As a general rule, the inclusion criteria of this procedure should be employed for early gastric cancer in the middle third of the stomach, more than 4 cm apart from the pyloric ring, without lymph node metastases in the preoperative examination, such as computed tomography and endoscopic ultrasonography. The mobilization of the stomach and the dissection of the regional lymph nodes are performed with almost a same method of the conventional gastrectomy, except for preservation of the infrapyloric artery and omission of the suprapyloric lymph node dissection. Intracorporeal gastrogastrostomy is undertaken by a functional end-to-end anastomosis using linear staplers between both posterior walls of the proximal and distal gastric remnants, which called ‘delta-shaped anastomosis.
(Results) Between August 2010 and March 2011, we carried out this procedure for 36 cases of early gastric cancer. The patients had uneventful postoperative courses except one patient, who suffered from mminor pancreatic fistula treated conservatively.
(Conclusion) Laparoscopic pylorus-preserving gastrectomy with intracorporeal delta-shaped anastomosis is a useful procedure with regard to treatment for early gastric cancer in the middle portion of the stomach.

Session Number: Poster – Poster Presentations
Program Number: P193
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