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Advantage of Completely Laparoscopic Gastrectomy With Linear Stapled Reconstruction: A Long-term Follow-up Study

Okabe, Hiroshi MD, PhD; Obama, Kazutaka MD, PhD; Tsunoda, Shigeru MD, PhD; Tanaka, Eiji MD, PhD; Sakai, Yoshiharu MD, PhD

doi: 10.1097/SLA.0b013e31828dfa5d
Original Articles

Background: Completely laparoscopic gastrectomy with intracorporeal anastomosis was introduced to achieve safer anastomosis and smaller scars. Although several reports have shown the feasibility of linear-stapled anastomosis, there are no studies of a large number of patients assessing the long-term complications and functional outcomes.

Methods: This retrospective study included 345 patients who had intended to undergo completely laparoscopic distal or total gastrectomy with linear-stapled anastomosis between September 2005 and January 2012. This study evaluated both the short- and long-term complications, as well as the endoscopic findings, changes in body weight and serum albumin.

Results: Completely laparoscopic gastrectomy was successfully achieved in 342 patients (99.1%). Short-term complications occurred in 59 patients (17.3%). Reconstruction-related complications were observed in 19 patients (5.6%). Three patients with anastomotic leakage required reoperation. No patient experienced anastomotic stenosis over a mean follow-up period of 29.6 months. Two patients underwent an emergency operation for an internal hernia after total gastrectomy. Adhesive intestinal obstruction was observed in 5 patients (1.5%), but all were resolved without surgical intervention. Body weight loss at 2 years after distal and total gastrectomy was 7.2% and 13.9%, which were similar to previous reports of open surgery.

Conclusions: Completely laparoscopic gastrectomy with linear-stapled anastomosis is a feasible choice for gastric cancer patients with some potential long-term advantages such as less anastomotic stenosis and fewer adhesive intestinal obstructions.

Supplemental Digital Content is Available in the Text.Among 345 gastric cancer patients who underwent completely laparoscopic gastrectomy, short-term reconstruction-related complications occurred in 19 patients (5.6%). During mean follow-up period of 29.6 months, no patient experienced anastomotic stenosis, and adhesive intestinal obstruction occurred in 5 patients (1.5%), but all were resolved without surgical intervention.

From the Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan.

Reprints: Hiroshi Okabe, MD, PhD, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. E-mail: hokabe@kuhp.kyoto-u.ac.jp.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

Disclosure: The authors declare no conflicts of interest, and no support has been taken from any source.

© 2014 by Lippincott Williams & Wilkins.