A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy

Background The purpose of this study is to depict a novel delta-shaped intracorporeal double-tract reconstruction (DT) for totally laparoscopic (TL) proximal gastrectomy (PG), and to evaluate its safety and feasibility by analyzing its surgical and postoperative outcomes. Patients and methods We retrospectively reviewed the cases of 21 patients who underwent TLPG and TLDT (TLPG-DT) from January to December 2014 in our hospital. The data of clinicopathologic characteristics, surgical and postoperative outcomes, and follow-up findings were collected and analyzed. Results The mean duration of the operation was 173.8 +/- 21.8 min, including 27.8 +/- 5.3 min of reconstruction. The blood loss was 109.2 +/- 96.3 mL. The mean number of LNs dissected was 25.7 +/- 4.7. The mean time of the first flatus was at postoperative day 2.3 +/- 1.0, and the mean postoperative hospital stay was 6.8 +/- 2.5 days. The early complications rate was 9.5 %, including one intraperitoneal hemorrhage and one pulmonary infection (both were managed through conservative methods and no re-operation occurred). The rate of complications in late stage was also 9.5 %, including one diarrhea and one reflux symptom claim. Among the total 21 cases, 17 patients were followed up more than 6 months, showing no signs of reflux esophagitis or anastomotic stenosis. The mean weight loss in 3 and 6 months after the operation was 4.3 and 5.7 %, respectively. Conclusion Totally laparoscopic delta-shaped intracorporeal double-tract reconstruction is a safe, feasible and minimally invasive reconstruction method with excellent postoperative outcomes in terms of preventing reflux esophagitis and anastomotic stenosis. TLPG-DT might serve as a promising treatment for proximal gastric cancer of early stage.