Delta-shaped Gastroduodenostomy In Fully Laparoscopic Distal Gastrectomy:a Clinical Study

Part I: Comparison of early-term effects between totally laparoscopic distal gastrectomy with delta-shaped anastomosis and conventional laparoscopic-assisted distal gastrectomyAim: To compare early-term effects of totally laparoscopic distal gastrectomy with delta-shaped anastomosis(D-STLDG)with conventional laparoscopic-assisted distal gastrectomy(LADG).Methods: Clinical data of 24 patients who received D-STLDG from April 2013 to April 2014,and 45 patients who received LADG from March 2010 to December 2012 were retrospectively analyzed.The operative time,intra-operative blood loss,post-operative recovery time of intestinal function,post-operative pain,the length of post-operative hospital stay and the incidence of post-operative complications(infection,obstruction and delayed gastric emptying)were compared between the two groups.Results: All procedures were completed successfully and all patients of both groups were discharged smoothly from hospital.Compared with LADG,D-STLDG had shorter operative time(175.3±64.7 min vs.205.8±42.2 min,P<0.05),less intra-operative blood(50.8±25.3 ml vs.75.2±22.5 ml,P<0.05),shorter post-operative recovery time of intestinal function(1.2±0.5 d vs.2.1±0.8 d,P<0.05),less post-operative pain(5.6±0.7 vs.7.8±0.5,P<0.05),shorter post-operative hospital stay(8.5±2.2 d vs.10.5±3.5 d,P<0.05).There were no significant difference in surgical margins achieved,the number of lymph nodes retrieved or the incidence of post-operative complications(infection,obstruction and delayed gastric emptying)(P>0.05).Conclusion: The delta-shaped anastomosis of reconstructing the digestive tract in TLDG appears to be safe,feasible and associated to faster recovery.Part II: Delta-Shaped Gastroduodenostomy in Fully Laparoscopic Distal GastrectomyAim: This study aims to explore the technical feasibility,safety,and clinical efficacy of delta-shaped anastomosis for digestive tract reconstruction during totally laparoscopic distal gastrectomy.Method: Clinical data of 24 patients who received totally laparoscopic distal gastrectomy with delta-shaped anastomosis(laparoscopic gastrectomy group,LG group)and 30 patients who received open distal gastrectomy for gastric cancer(open gastrectomy group,OG group)from April 2013 to April 2014 were retrospectively analyzed.Operation time,intraoperative blood loss,postoperative time to intestinal function recovery,postoperative pain,postoperative hospital stay,and incidence of postoperative complications(infection,obstruction,and delayed gastric emptying)were compared between these 2 groups.Results: Patients in both groups were discharged without marked complications.No patients who initially selected laparoscopy were convertedto laparotomy.Patients in the LG group had longer operation times(175.3±64.7 minutes versus 120.1±43.4 minutes,p<0.05),lower intraoperative blood loss(50.8±25.3m L versus 95.6±20.7 m L,p<0.05),faster recovery of intestinal function(1.2±0.5 days versus 2.6±1.0 days,p<0.05),less postoperative pain(5.6±0.7 versus 9.5±0.3,p<0.05),and shorter length of postoperative hospital stay(8.5±2.2 days versus 12.2±3.8 days,p<0.05),compared with patients in the OG group.There were no significant differences with respect to surgical margins achieved,the number of lymph nodes retrieved or incidence of postoperative complications(infection,obstruction,and delayed gastric emptying)between the 2 groups(p>0.05).Conclusion: Laparoscopic reconstruction of the digestive tract through delta shaped anastomosis appears to be safe,feasible,and associated to rapid recovery.These data argue for more wide-spread implementation of this procedure.