Comparing short-term outcomes after totally laparoscopic distal gastrectomy and laparoscopy-assisted distal gastrectomy with Billroth I anastomosis: early experience of a single institution

Inhyuck Lee; Kwang Hee Kim; Sang Hyuk Seo; Min Sung An; HyungJoo Baik; Yo Han Park; Sang Hyun Kang; Sang Hoon Oh

doi:10.7602/jmis.2021.24.1.26

Comparing short-term outcomes after totally laparoscopic distal gastrectomy and laparoscopy-assisted distal gastrectomy with Billroth I anastomosis: early experience of a single institution

J Minim Invasive Surg. 2021 Mar 15;24(1):26-34. doi: 10.7602/jmis.2021.24.1.26.

Authors

Inhyuck Lee¹, Kwang Hee Kim¹, Sang Hyuk Seo¹, Min Sung An¹, HyungJoo Baik¹, Yo Han Park¹, Sang Hyun Kang¹, Sang Hoon Oh¹

Affiliation

¹ Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea.

Abstract

Purpose: To determine the safety and feasibility of totally laparoscopic distal gastrectomy (TLDG) with modified delta-shaped anastomosis, we compared the short-term outcomes of TLDG to those of laparoscopy-assisted distal gastrectomy (LADG) with Billroth I anastomosis.

Methods: We analyzed the characteristics of 85 patients with gastric cancer who underwent laparoscopic distal gastrectomy with Billroth I anastomosis between January 2013 and December 2018. After propensity score matching, each group had 35 patients.

Results: Of these 85 patients, 44 underwent TLDG and 41 underwent LADG. Propensity score matching was performed with three covariates (age, underlying disease, and hypertension), and 35 patients from each group were matched 11. After matching, the TLDG group was older than the LADG group (64.5 ± 10.6 years vs. 56.3 ± 11.2 years, p = 0.003) and had more patients with hypertension (57.1% vs. 22.9%, p = 0.003). Tumors were larger in the TLDG group than in the LADG group (23.4 ± 16.2 mm vs. 16.0 ± 7.9 mm, p = 0.018). A greater proportion of patients had fever in the TLDG group than the LADG group (42.9% vs. 20.0%, p = 0.039), and C-reactive protein from postoperative days 3 to 6 was greater in the TLDG group (11.4 ± 5.7 mg/dL vs. 7.0 ± 5.0 mg/dL, p = 0.001).

Conclusion: Although our data represent only our early experience performing TLDG with modified delta-shaped anastomosis, this procedure is relatively safe and feasible. Nevertheless, compared to LADG, which is the conventional method, the operative time for TLDG was longer. Surgeons must also watch out for anastomotic complications.

Keywords: Gastroenterostomy; Laparoscopy; Stomach neoplasms.