Laparoscopic Surgery for Gastric and Duodenal Disease

ABSTRACT

PURPOSE: The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic surgery in the treatment of gastric and duodenal diseases. METHODS: 27 patients who suffered from various gastroduodenal diseases were operated on between Feb. 1996 and July 1997. Operating times, procedures associated with pathologic diagnosis, bleeding during operation, mean starting times of oral intake, postoperative hospital stays, and complications were examined using the operating records and the medical charts. RESULTS: The procedures and the associated pathologic conditions were a feeding jejunostomy (gastric cancer peritonei), 12 wedge resections (1 duodenal diverticulum, 1 Brunner's gland hyperplasia, 2 gastric polyps, 6 gastrointestinal stromal tumors, and 2 early gastric carcinomas, 3 gastrojejunostomies (unresectable gastric cancers), 10 subtotal gastrectomies (9 complicated peptic ulcers and early gastric cancer), and a radical (D1 alpha) subtotal gastrectomy. The average operating times were 85 minutes in the feeding jejunostomy, 132 minutes in the wedge resections, 95 minutes in the gastro jejunostomies, 208 minutes in the subtotal gastrectomies (Billroth-I 160 min; Billroth-II 262 min.), and 300 minutes in the radical operation. The mean intraoperative bleeding was 80-800 cc. The mean start ing time of solid oral intake and postopeative hospital stay were shorter than in open surgery (oral intake 1-5 day; hospital stay 6-9 days). There were six postoperative complications. One patient died due to a cerebral infarction during the operation. one wound infection, one stump leakage, one pulmonary edema, and two cases of postoperative bleeding occurred, but they were treated conventionally without reoperation. CONCLUSION: Minimally invasive surgery appears to be an invaluable tool for treating gastroduodenal diseases. Furthermore, it is a valid option in experienced hands and in selected cases of gastric cancer, allowing patients to benefit from a less cumbersome hospital stay and from more satisfaction.