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International Session (Symposium)4 (JSGS・JSGE)
Fri. October 13th   9:40 - 12:00   Room 10: Fukuoka International Congress Center 501
Intracorporeal anastomosis in laparoscopic distal gastrectomy
S. Kanaya
Department of Gastrointestinal Surgery, Osaka Red Cross Hospital
Background: More than 15 years have passed since we developed the delta-shaped anastomosis, an intracorporeal gastroduodenostomy using endoscopic linear staplers. In this paper, we examined three methods of intracorporeal anastomoses, Billroth-I (B-I), Billroth-II (B-II) and Roux-en Y (R-Y), and their outcomes. Methods: We retrospectively analyzed 380 consecutive gastric cancer patients who underwent laparoscopic distal gastrectomy (LDG) from April 2011 to March 2016. Of the 380 patients, 265 underwent intracorporeal B-I, 77 underwent B-II, and 38 had R-Y reconstruction. Patient characteristics and postoperative outcomes were assessed. Results: There was no conversion to laparoscopic-assisted gastrectomy with extracorporeal anastomosis. The median operation time varied among the three groups: B-I < B-II < R-Y (p < 0.001). Regarding postoperative complications, anastomotic leakage occurred in four patients (1.5%) in B-I group, two patients (2.6%) in B-II group, and none (0.0%) in R-Y group. No anastomotic stenosis occurred in any group. Anastomotic bleeding occurred in one patient (0.4%) in B-I group. Delayed gastric emptying occurred in two patients (0.8%) in B-I group, one patient (1.3%) in B-II group, and one patient (2.6%) in R-Y group. Conclusions: Intracorporeal anastomosis in LDG is safe and feasible. Our three reconstruction methods enable us to treat all gastric cancer patients who need distal gastrectomy laparoscopically with good results.
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