A secure technique of intracorporeal Roux-Y reconstruction after laparoscopic distal gastrectomy

• Published in: The American journal of surgery Vol. 189; no. 2; pp. 178 - 183
• Main Authors: Takaori, Kyoichi, Nomura, Eiji, Mabuchi, Hideaki, Lee, San-Woong, Agui, Tomoyuki, Miyamoto, Yoshiharu, Iwamoto, Mitsuhiko, Watanabe, Hisashi, Tanigawa, Nobuhiko
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2005; Elsevier; Elsevier Limited
• Subjects: Aged; Analgesics; Anastomosis, Roux-en-Y; Biological and medical sciences; Cancer; Digestive system. Abdomen; Dissection; Endoscopy; Female; Gastrectomy - methods; Gastric cancer; General aspects; Humans; Intracorporeal anastomosis; Investigative techniques, diagnostic techniques (general aspects); Jejunum - surgery; Laparoscopy; Laparoscopy - methods; Lymphatic system; Male; Medical sciences; Middle Aged; Roux-Y reconstruction; Stomach - surgery; Stomach Neoplasms - surgery; Surgical techniques; Suture Techniques; Veins & arteries; Roux-Y reconstruction; Intracorporeal anastomosis; Laparoscopy; Gastric cancer; Medicine; Reconstruction; Treatment; Surgery; Distal; Endoscopy; Technique; Gastrectomy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2004.09.008

Laparoscopic distal gastrectomy [LDG] is a minimally invasive surgery for gastric carcinoma. The Billroth I method has been commonly employed to reconstruct alimentary tract after LDG. Conversely, Roux-Y reconstruction is employed far less commonly despite its merits. Technical difficulties, including a risk of twisting the Roux loop under limited vision through a laparoscope, have hampered Roux-Y reconstruction after LDG. We performed LDG and intracorporeal Roux-Y reconstruction in 5 patients with early gastric cancer. The procedure included a functional end-to-end anastmosis of the stomach and jejunum, consisting of side-to-side approximation of jejunal loop to greater curvature of the gastric remnant with a laparoscopic stapling device followed by closure of the open end and simultaneous division of the jejunum with another stapler. Roux-Y reconstruction was successfully accomplished without torsion of the loop in all patients. By using the present technique, intracorporeal Roux-Y reconstruction after LDG can be accomplished without a risk of twisting the jejunal loop.