Document Detail

An effective duodenum bulb mobilization for extracorporeal Billroth I anastomosis of laparoscopic gastrectomy.
MedLine Citation:
PMID:  18795375     Owner:  NLM     Status:  MEDLINE    
BACKGROUND DATA: Extracorporeal circular-stapled Billroth I (B-I) anastomosis is difficult in patients with obesity, a large body shape, or small remnant stomach, as it requires the duodenal stump to be lifted outside of the wound. The aim of this study was to evaluate the feasibility of circular-stapled B-I reconstruction for laparoscopy-assisted distal gastrectomy (LADG) with effective duodenal mobilization. METHODS: Between March 2005 and December 2007, 199 patients with early gastric cancer underwent LADG with B-I reconstruction in the Department of Gastrointestinal Surgery at the Cancer Institute. The greater omentum, comprised of four membrane layers, was completely dissected for effective duodenal bulb mobilization to allow easy performance of extracorporeal end-to-end gastroduodenostomy. Several clinicopathophysiological features relating to anastomosis complications, including anastomotic leakage, stenosis, bleeding, and ulcers, were evaluated. RESULTS: The success rate of extracorporeal circular-stapled B-I anastomosis was 100% for the 199 patients, 24% of whom had a body mass index greater than 25. The rate of anastomosis-related postoperative complications was 2%. Anastomotic leakage was not observed in this study. Anastomotic stenosis was observed in 2 (1%) patients, anastomotic bleeding was observed in 1 (0.5%) patient, and anastomotic ulcer was diagnosed in 1 (0.5%) patient. All these complications were managed conservatively. There was no postoperative mortality. CONCLUSIONS: Feasible duodenal bulb mobilization by complete dissection of the greater omentum allows easy performance of extracorporeal B-I anastomosis and minimizes complications related to anastomosis in LADG.
Naoki Hiki; Testsu Fukunaga; Masanori Tokunaga; Shigekazu Ohyama; Kazuhiko Yamada; Akio Saiura; Toshiharu Yamaguchi
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Publication Detail:
Type:  Journal Article     Date:  2008-09-16
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  13     ISSN:  1873-4626     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-02     Completed Date:  2009-06-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  230-5     Citation Subset:  IM    
Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo 135-8550, Japan.
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MeSH Terms
Adenocarcinoma / pathology,  surgery*
Aged, 80 and over
Body Mass Index
Cohort Studies
Duodenum / surgery
Feasibility Studies
Gastroenterostomy / methods*
Middle Aged
Retrospective Studies
Stomach Neoplasms / pathology,  surgery*
Surgical Stapling / methods*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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