Nobuhiro Kurita, PhD, Mitsuo Shimada, PhD, Takashi Iwata, PhD, Hirohiko Sato, PhD, Kozo Yoshikawa, PhD, Jun Higashijima, PhD, Tomohiko Miyatani, PhD, Hideya Kashihara, MD, Chie Takasu, MD, Noriko Matsumoto, MD
Department of Surgery, The University of Tokushima
INTRODUCTION: To investigate the profile and measures of postoperative complications after lapraroscopy assisted gastrectomy (LAG) for gastric cancer
PATIENTS AND METHODS
1 .Profile: The postoperative conplications of the 217 patients who underwent LAG for gastric cancer were studied according to operative factors (operative time, blood loss, VFA: visceral fat area, learning curve).
2. Delayed gastric emptying (DGE): The incidence of delay according to gastrojejunostomy in the 133 patients underwent standardized LAG with Roux-en-Y (R-Y) reconstruction: A group (n=81), A 60mm linear stapler was inserted along the greater curvature. B group (n=24), The remnant stomach and the jejunum was anastomosed by end-to-end hand-sewn. C group (n=5), A 60mm linear stapler was inserted for E-G junction. The entry hole was closed by hand-sewn in Group A and C.
3. Internal hernia: The incidence of internal hernia was evaluated before and after closure of the hernia hilus.
1. The incidence of postoperative complications was 16.1% (n=35). Major complications were DGE 6.9% (n=15: LADG+R-Yreconstruction), pancreatic fistula 3.6% (n=8), pacreatic The incidence of pancreatic fistula in VFA >100cm2 was significantly higher than that in VFA <100cm2. There were no corelations between major complications and operative factors. Other complication were wond infection 5, pneumonia 3, leakage of anastomisis 2, postoperativer bleeding 1, stenosis of anastomosis 1. In obese patinets, careful operation is needed to prevent pancreatic fistula.
2. The incidence of DGE was 11.3% (n=15), and 16.0% (n=13) in Group A, 4.2% (n=1) in Group B, 3.6% (n=1) in Group C, respectively. Gastrojejunstomy along grater curvature in Group A could cause bending of it and lead to DGE. Patients with DGE had longer operation time (330 vs 290 min), higher ratio of D2 dissection.
3. 6 patinets (3.0%) had inernal hernia after 10-48 months after LAG+R-Y. The hilus was Y limb : 3, Petersen : 2, esophageal hilus :1. The hilus was closed in recent 30 patients and there are no inernal hernia in these patients.
CONCLUSION: The postoperative complications can be more reduced by appropriate operative procedures.
Session: Poster Presentation
Program Number: P218