Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer / 대한외과학회지

PURPOSE: In laparoscopic distal gastrectomy for gastric cancer, most surgeons prefer extra-corporeal anastomosis because of technical challenges and unfamiliarity with intra-corporeal anastomosis. Herein, we report the feasibility and safety of intra-corporeal Billroth-II anastomosis in gastric cancer. METHODS: From April 2004 to March 2011, 130 underwent totally laparoscopic distal gastrectomy with intra-corporeal Billroth-II reconstruction, and 269 patients underwent laparoscopy-assisted distal gastrectomy with extra-corporeal Billroth-II reconstruction. Surgical efficacies and outcomes between two groups were compared. RESULTS: There were no differences in demographics and clinicopathological characteristics. The mean operation and reconstruction times of totally laparoscopic distal gastrectomy were statistically shorter than laparoscopy-assisted distal gastrectomy (P = 0.019; P < 0.001). Anastomosis-related complications were observed in 11 (8.5%) totally laparoscopic distal gastrectomy and 21 (7.8%) laparoscopy-assisted distal gastrectomy patients, and the incidence of these events was not significantly different. Post-operative hospital stays for totally laparoscopic distal gastrectomy were shorter than laparoscopy-assisted distal gastrectomy patients (8.3 +/- 3.2 days vs. 9.9 +/- 5.3 days, respectively; P = 0.016), and the number of times parenteral analgesic administration was required in laparoscopy-assisted distal gastrectomy patients was more frequent after surgery. CONCLUSION: Intra-corporeal Billroth-II anastomosis is a feasible procedure and can be safely performed with the proper experience for laparoscopic distal gastrectomy. This method may be less time consuming and may produce a more cosmetic result.

Retrograde Jejuno-gastric Intussusception

Retrograde jejuno-gastric intussusception is an unusual complication after gastroenterostomy. It is very difficult to diagnosis this illness before endoscopy or operation, so a high clinical suspicion is needed to make the diagnosis .There have been only 300 reported cases of this illness. There are four types of jejuno-gastric intussusception that are defined anatomically. Intussusception of the efferent limb of the jejunum is the most frequent type. Although the causative factors are not well known, this disease has a poor outcome unless it's treats promptly within 48 hours. We report here a case of hematemesis caused by intussusceptum from the efferent limb to the afferent limb of Braun anastomosis.

Retrograde Jejunogastric Intussusception: A Rare Complication of Gastric Surgery

Retrograde jejunogastric intussusception is a rare complication of gastric surgery. We report a case of retrograde jejunogastric intussusception that developed after a gastric resection. The patient was a 62 years old female patient who complained severe epigastric pain, vomiting and hematemesis. She had a gastric resection and Billroth II anastomosis performed using the Braun procedure 6 months prior because of early gastric cancer. At the time of admission, the plain abdomen revealed an ileus change, but the vital signs and symptoms had worsened. An emergency operation was therefore performed and a strangulated retrograde jejunogastric intussusception of efferent loop was discovered. Surgical management consisted of a segmental resection of the jejunum. It is recommended that treatment be done as early as possible in order to prevent a strangulation of the invaginated segment. This case illustrates the rare complications of a type 2b retrograde jejunogastric intussusception that developed more than 6 months after a gastric resection and a Billroth II anastomosis using the Braun procedure.