LAPAROSCOPIC DISTAL GASTRECTOMY WITH INTRACORPOREAL HAND-SEWN BILLROTH-I ANASTOMOSIS (ICHSA) - NO USE OF AUTOMATIC SUTURING INSTRUMENTS.
EAES Online Library. Matsuo K. Jan 10, 2012; 20016
Dr. Katsuichi Matsuo
Dr. Katsuichi Matsuo
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Abstract
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Background In recent years, the number of cases of laparoscopic surgery for treating early gastric cancer has been increasing. In this study, by placing an anchor thread on a suture line on the lesser curvature of the stomach, we simplified the procedure for intracorporeal hand-sewn anastomosis and safely performed hand-sewn gastroduodenal anastomosis.
Patients and Method From January 2009 to August 2010, we performed hand-sewn gastroduodenal anastomosis in 17 cases. After performing lymph node dissection, the duodenum and the stomach were separated using an automatic suture device. Anchor sutures were placed on the suture line of the lesser curvature of the stomach. First, the seromuscular layer of the stomach and the seromuscular layer of the duodenum were sutured by performing interrupted suturing using an extracorporeal knot-tying method. With the stomach and the duodenum in a fixed state, the anastomosis area was opened. The thread of the anchor suture was pulled toward the abdominal wall, and then all layers of the stomach and the duodenum at the posterior wall were continuously sutured. Similarly, for the anterior wall, all layers were continuously sutured from the lesser curvature toward the greater curvature.
Results The mean time required for the anastomosis was 64.8±11.5 minutes, and the estimated blood loss was 56.1±92.8g. All operation was curative, and the mean number of retrieved lymph node was 26.9±11.2. Postoperative complications included 1 case of a ruptured suture, but this was resolved through a conservative approach. 
Conclusions We performed gastroduodenal anastomosis under a total laparoscopic approach by hand-sewn. This method is economical, as it does not require the use of machinery for anastomosis, and the duodenal stump is short, and we believe this method, which can be performed in a similar manner even for obese patients, can be used as a standard method of anastomosis.
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