Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomyReportar como inadecuado

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World Journal of Surgical Oncology

, 10:267

First Online: 12 December 2012Received: 28 August 2012Accepted: 24 November 2012


BackgroundLaparoscopic gastrectomy has recently been gaining popularity as a treatment for cancer; however, little is known about the benefits of intracorporeal IC gastrointestinal anastomosis with pure laparoscopic distal gastrectomy LDG compared with extracorporeal EC anastomosis with laparoscopy-assisted distal gastrectomy LADG.

MethodsBetween June 2000 and December 2011, we assessed 449 consecutive patients with early-stage gastric cancer who underwent LDG. The patients were classified into three groups according to the method of reconstruction LADG followed by EC hand-sewn anastomosis LADG + EC n = 73, using any of three anastomosis methods Billroth-I B-I, Billroth-II B-II or Roux-en-Y R-Y; LDG followed by IC B-I anastomosis LDG + B-I n = 248; or LDG followed by IC R-Y anastomosis LDG + R-Y n = 128. The analyzed parameters included patient and tumor characteristics, operation details, and post-operative outcomes.

ResultsThe tumor location was significantly more proximal in the LDG + R-Y group than in the LDG + B-I group P < 0.01. Mean operation time, intra-operative blood loss, and the length of post-operative hospital stay were all shortest in the LDG + B-I group P < 0.05. Regarding post-operative morbidities, anastomosis-related complications occurred significantly less frequently in with the LDG + B-I group than in the LADG + EC group P < 0.01, whereas there were no differences in the other parameters of patients’ characteristics.

ConclusionsIntracorporeal mechanical anastomosis by either the B-I or R-Y method following LDG has several advantages over at the LADG + EC, including small wound size, reduced invasiveness, and safe anastomosis. Although additional randomized control studies are warranted to confirm these findings, we consider that pure LDG is a useful technique for patients with early gastric cancer.

KeywordsLaparoscopic distal gastrectomy Intracorporeal anastomosis Extracorporeal anastomosis Billroth I Roux-en-Y Electronic supplementary materialThe online version of this article doi:10.1186-1477-7819-10-267 contains supplementary material, which is available to authorized users.

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Autor: Sang-Woong Lee - Nobuhiko Tanigawa - Eiji Nomura - Takaya Tokuhara - Masaru Kawai - Kazutake Yokoyama - Masako Hiramatsu -


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