Intracorporeal Billroth 1 Reconstruction by Triangulating... : Surgical Laparoscopy Endoscopy & Percutaneous Techniques (original) (raw)

Technical Reports

Intracorporeal Billroth 1 Reconstruction by Triangulating Stapling Technique After Laparoscopic Distal Gastrectomy for Gastric Cancer

Tanimura, Shinya MD*; Higashino, Masayuki MD*; Fukunaga, Yosuke MD*; Takemura, Masashi MD*; Nishikawa, Takayuki MD*; Tanaka, Yoshinori MD*; Fujiwara, Yushi MD*; Osugi, Harushi MD†

*Department of Gastroenterological Surgery, Osaka City General Hospital

†Department of Gastroenterological Surgery, School of Medicine, Osaka City University, Osaka, Japan

Reprints: Shinya Tanimura, MD, Department of Gastroenterological Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan (e-mail: [email protected]).

Received for publication July 17, 2006; accepted June 29, 2007

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 18(1):p 54-58, February 2008. | DOI: 10.1097/SLE.0b013e3181568e63

Abstract

As the laparoscopic operations for gastric cancer have increased, the intracorporeal reconstruction of the digestive tract has received attention because the procedure offers a good visual field regardless of the patient's figure. We performed laparoscopic gastrectomies with regional lymph node dissection on 586 gastric cancer patients between March 1998 and June 2006: 465 distal gastrectomies, 42 proximal gastrectomies, and 79 total gastrectomies. Intracorporeal anastomosis was carried out in 303, 36, and 69 of the above cases, respectively. The intracorporeal Billroth 1 reconstruction was performed in 226 out of the 303 cases who underwent distal gastrectomy and intracorporeal anastomosis. The “triangulating stapling technique” (TST) that uses laparoscopic linear stapling devices was adopted for 196 of these 226 cases; in the remaining 30, circular stapling devices for conventional open gastrectomy (CEEA) were used. In the initial 115 cases of distal gastrectomy, hand-assisted laparoscopic surgery (HALS) was used, and then we shifted to totally laparoscopic distal gastrectomy (TLDG) without HALS. In this paper, we concentrated on the techniques and results of intracorporeal Billroth 1 reconstruction by TST. Reducing postoperative wounds was possible TLDG by TST, compared with HALS and the extracorporeal anastomosis, that is, laparoscopy-assisted distal gastrectomy. Complications from anastomosis resulted in leakage in 2 HALS-TST patients and in 1 TLDG-TST patient, and anastomotic stenosis and bleeding were observed in each 1 case of reconstruction that used CEEA. Intracorporeal Billroth 1 reconstruction by TST is a safe procedure that provides a good visual field regardless of the patient's figure and a feasible technique for reconstruction after laparoscopic distal gastrectomies.