Progression from laparoscopic-assisted to totally laparoscopic distal gastrectomy

Comparison of circular stapler (i-DST) and linear stapler (BBT) for intracorporeal anastomosis

Tetsuo Ikeda, Hiroyuki Kawano, Yuichi Hisamatsu, Kouji Andou, Hiroshi Saeki, Eiji Oki, Takefumi Ohga, Yoshihiro Kakeji, Shunichi Tsujitani, Shunji Kohnoe, Yoshihiko Maehara

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Billroth I (B-I) gastroduodenostomy is an anastomotic procedure that is widely performed after gastric resection for distal gastric cancer. A circular stapler often is used for B-I gastroduodenostomy in open and laparoscopic-assisted distal gastrectomy. Recently, totally laparoscopic distal gastrectomy (TLDG) has been considered less invasive than laparoscopic-assisted gastrectomy, and many institutions performing laparoscopic-assisted distal gastrectomy are trying to progress to TLDG without markedly changing the anastomosis method. The purpose of this report is to introduce the technical details of new methods of intracorporeal gastroduodenostomy using either a circular or linear stapler and to evaluate their technical feasibility and safety. Methods: Seventeen patients who underwent TLDG with the intracorporeal double-stapling technique using a circular stapler (n = 7) or the book-binding technique (BBT) using a linear stapler (n = 10) between February 2010 and April 2011 were enrolled in the study. Clinicopathological data, surgical data, and postoperative outcomes were analyzed. Results: There were no intraoperative complications or conversions to open surgery in any of the 17 patients. The usual postoperative complications following gastroduodenostomy, such as anastomotic leakage and stenosis, were not observed. Anastomosis took significantly longer to complete with DST (64 ± 24 min) than with BBT (34 ± 7 min), but more stapler cartridges were needed with BBT than with DST. Conclusions: TLDG using a circular or linear stapler is feasible and safe to perform. DST will enable institutions performing laparoscopic-assisted distal gastrectomy with circular staplers to progress to TLDG without problems, and this progression may be more economical because fewer stapler cartridges are used during surgery. However, if an institution has already been performing δ anastomosis in TLDG but has been experiencing certain issues with δ anastomosis, converting from δ anastomosis to BBT should be beneficial.

Original languageEnglish
Pages (from-to)325-332
Number of pages8
JournalSurgical endoscopy
Volume27
Issue number1
DOIs
Publication statusPublished - Jan 1 2013

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Gastrectomy
Gastroenterostomy
Conversion to Open Surgery
Anastomotic Leak
Intraoperative Complications
Stomach Neoplasms
Stomach
Pathologic Constriction
Safety

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Progression from laparoscopic-assisted to totally laparoscopic distal gastrectomy : Comparison of circular stapler (i-DST) and linear stapler (BBT) for intracorporeal anastomosis. / Ikeda, Tetsuo; Kawano, Hiroyuki; Hisamatsu, Yuichi; Andou, Kouji; Saeki, Hiroshi; Oki, Eiji; Ohga, Takefumi; Kakeji, Yoshihiro; Tsujitani, Shunichi; Kohnoe, Shunji; Maehara, Yoshihiko.

In: Surgical endoscopy, Vol. 27, No. 1, 01.01.2013, p. 325-332.

Research output: Contribution to journalArticle

Ikeda, Tetsuo ; Kawano, Hiroyuki ; Hisamatsu, Yuichi ; Andou, Kouji ; Saeki, Hiroshi ; Oki, Eiji ; Ohga, Takefumi ; Kakeji, Yoshihiro ; Tsujitani, Shunichi ; Kohnoe, Shunji ; Maehara, Yoshihiko. / Progression from laparoscopic-assisted to totally laparoscopic distal gastrectomy : Comparison of circular stapler (i-DST) and linear stapler (BBT) for intracorporeal anastomosis. In: Surgical endoscopy. 2013 ; Vol. 27, No. 1. pp. 325-332.
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abstract = "Background: Billroth I (B-I) gastroduodenostomy is an anastomotic procedure that is widely performed after gastric resection for distal gastric cancer. A circular stapler often is used for B-I gastroduodenostomy in open and laparoscopic-assisted distal gastrectomy. Recently, totally laparoscopic distal gastrectomy (TLDG) has been considered less invasive than laparoscopic-assisted gastrectomy, and many institutions performing laparoscopic-assisted distal gastrectomy are trying to progress to TLDG without markedly changing the anastomosis method. The purpose of this report is to introduce the technical details of new methods of intracorporeal gastroduodenostomy using either a circular or linear stapler and to evaluate their technical feasibility and safety. Methods: Seventeen patients who underwent TLDG with the intracorporeal double-stapling technique using a circular stapler (n = 7) or the book-binding technique (BBT) using a linear stapler (n = 10) between February 2010 and April 2011 were enrolled in the study. Clinicopathological data, surgical data, and postoperative outcomes were analyzed. Results: There were no intraoperative complications or conversions to open surgery in any of the 17 patients. The usual postoperative complications following gastroduodenostomy, such as anastomotic leakage and stenosis, were not observed. Anastomosis took significantly longer to complete with DST (64 ± 24 min) than with BBT (34 ± 7 min), but more stapler cartridges were needed with BBT than with DST. Conclusions: TLDG using a circular or linear stapler is feasible and safe to perform. DST will enable institutions performing laparoscopic-assisted distal gastrectomy with circular staplers to progress to TLDG without problems, and this progression may be more economical because fewer stapler cartridges are used during surgery. However, if an institution has already been performing δ anastomosis in TLDG but has been experiencing certain issues with δ anastomosis, converting from δ anastomosis to BBT should be beneficial.",
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T2 - Comparison of circular stapler (i-DST) and linear stapler (BBT) for intracorporeal anastomosis

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AU - Kawano, Hiroyuki

AU - Hisamatsu, Yuichi

AU - Andou, Kouji

AU - Saeki, Hiroshi

AU - Oki, Eiji

AU - Ohga, Takefumi

AU - Kakeji, Yoshihiro

AU - Tsujitani, Shunichi

AU - Kohnoe, Shunji

AU - Maehara, Yoshihiko

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