Effect of standardizing the incision line on delayed gastric emptying after laparoscopic gastrectomy: A retrospective preliminary analysis

Background: The use of totally laparoscopic surgery with Billroth-I reconstruction (delta-shaped anastomosis) has rapidly become widespread in recent years. However, we experienced delayed gastric emptying (DGE) in the early period after introduction of this technique. To the best of our knowledge, there are no report mentioned the incision line to prevent DGE in distal gastrectomy. In the present study, we standardized the surgical techniques, including the gastric incision line and compared the short-term results before and after standardization. Methods: A total of 86 patients were enrolled in this study. 28 procedures were performed in the early period and 58 procedures were performed in the late period, and the 2 groups were compared retrospectively. Results: The operation time decreased significantly after standardization from 288 min to 224 min (P < 0.001). The median value of perioperative bleeding volume reduced from 22.5 mL to 12.5 mL (P =0.060). There were no postoperative complications related to the site of anastomosis in either group. 5 cases of DGE (17.8%) was noted in the early period, but only 2 cases (3.4%) in the late period (P =0.022). Conclusions: Standardization of the incision line after laparoscopic gastrectomy resulted in a decline in incidence of DGE.

Clinicopathologic features of remnant gastric cancer after curative distal gastrectomy according to previous reconstruction method: a retrospective cohort study

Background Survival rate of patients treated for gastric cancer has increased due to early detection and improvements of surgical technique and chemotherapy. Increase in survival rate has led to an increase in the risk for remnant gastric cancer (RGC). The purpose of this study was to investigate clinicopathologic features of RGC according to previous reconstruction method and factors affecting the interval from previous curative distal gastrectomy for gastric cancer to RGC occurrence. Methods Medical records of patients diagnosed with RGC at Yeungnam University Medical Center from January 2000 to December 2017 who had a history of distal gastrectomy with D2 LN dissection due to gastric cancer were reviewed retrospectively. Results Forty-eight patients were enrolled in this study. The mean interval of 48 RGC patients was 105.6 months (8.8 years). RGC after Billroth II reconstruction recurred more often at anastomosis site than RGC after Billroth I reconstruction (p = 0.001). The mean interval of RGC after Billroth I reconstruction was 67 months, shorter than 119 months of RGC after Billroth II reconstruction (p = 0.003). On the contrary, interval showed no difference according to stage of previous gastric cancer, remnant gastric cancer, or sex (p = 0.810, 0.145, and 0.372, respectively). Conclusions RGC after Billroth I reconstruction tends to arise earlier at non-anastomosis site than RGC after Billroth II. Therefore, we should examine non-anastomosis site carefully from the beginning of surveillance after gastric cancer surgery with Billroth I reconstruction for better outcome.