Totally Laparoscopic Billroth II Gastrectomy with a Novel, Safe, Simple, and Time-Saving Anastomosis by Only Stapling Devices

Totally laparoscopic gastrectomy represents the evolution of laparoscopy-assisted gastrectomy. Most surgeons prefer laparoscopy-assisted gastrectomy rather than totally laparoscopic procedures because of technical difficulties of intracorporeal anastomosis. We created one novel stapling anastomosis without hand-sewn technique in totally laparoscopic Billroth II gastrectomy. The feasibility and early surgical outcomes of totally laparoscopic Billroth II gastrectomy with stapling anastomosis and with hand-sewn anastomosis were introduced in this study. We retrospectively analyzed early surgical outcomes in 70 patients who underwent totally laparoscopic Billroth II distal gastrectomy for gastric cancer between January 2010 and July 2011. The patients were divided into hand-sewn and device groups according to whether intracorporeal anastomosis was performed by only hand-sewn technique (n = 36) or only stapling devices (n = 34). In the device group, the gastrojejunostomy was performed using a circular stapler, and an additional side-to-side jejunojejunostomy was made at the site of jejunal enterotomy. There was no difference in the mean number of lymph nodes retrieved in both groups. The blood loss (hand-sewn group 205.8 +/- 37.4 vs. device group 201.2 +/- 51.2 ml, p > 0.05) and hospital stay (hand-sewn group 6.5 +/- 3.7 vs. device group 5.9 +/- 4.1 days, p > 0.05) were similar in both groups. We found that intracorporeal anastomosis by totally stapling devices was associated with decreased operative time (hand-sewn group 239.0 +/- 40.1 vs. device group 203.6 +/- 27.9 min, p < 0.05). We suggest that intracorporeal anastomosis using only stapling devices in the described method was as safe and feasible as by hand-sewn technique. Moreover, it is a simple and time-saving method without any difficult hand-sewn procedures.