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Comparing the short-term outcomes of totally intracorporeal gastroduodenostomy with extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer: a single surgeon’s experience and a rapid systematic review with meta-analysis

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Abstract

Background

Since delta-shaped gastroduodenostomy was introduced, many surgeons have utilized laparoscopic distal gastrectomy (LDG) with totally intracorporeal Billroth I (ICBI) for gastric cancer, because it is expected to have several advantages over laparoscopic-assisted distal gastrectomy with extracorporeal Billroth I (ECBI). In this study, we compared these two reconstruction options to evaluate their outcomes.

Methods

The data of 166 gastric cancer patients who underwent LDG performed by a single surgeon between April 2009 and February 2012 were analyzed retrospectively. The subjects were divided into ECBI (n = 106) and ICBI (n = 60) groups, and then the clinical characteristics, surgical outcomes, symptoms, and change in BMI at 3 months after surgery were compared. Furthermore, a rapid systematic review and meta-analysis were conducted.

Results

The operative time was significantly shorter in the ICBI group (197.4 ± 45.5 vs. 157.1 ± 43.9 min), but blood loss was similar between the groups. Regarding surgical outcomes, there were no significant differences in the length of hospital stay, soft diet initiation, visual analogue scale, frequency of analgesics injection, and postoperative white blood cell counts and C-reactive protein levels between the groups. The surgical complication rates were 5.7 and 13.3 % in the ECBI and ICBI groups, respectively, and one case of anastomosis leakage was observed in each group. At 3 months after surgery, reflux symptoms were more frequent in the ICBI group, but other gastrointestinal symptoms and the change of BMI were similar between the groups. The meta-analysis revealed no significant differences in the operative time, time to first flatus, length of hospital stay, frequency of analgesic usages, and rates of anastomosis complications between the groups.

Conclusions

We could not demonstrate the clinical superiority of ICBI over ECBI based on our data and a rapid systematic review and meta-analysis. The anastomosis method may be selected according to patient conditions and the surgeon’s preference.

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Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2011-0011301). This study was supported by a faculty research grant of Yonsei University College of Medicine for 2011 (6-2011-0084).

Disclosures

Drs. Deok Gie Kim, Yoon Young Choi, Ji Yeong An, Jung Min Bae, Myung Gyu Song, In Gyu Kwon, In Cho, and Yoo Min Kim, Sung Hoon Noh have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

    Deok Gie Kim, Yoon Young Choi, Ji Yeong An, In Gyu Kwon, In Cho, Yoo Min Kim & Sung Hoon Noh

  2. Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jung Min Bae

  3. Department of Radiology, Korea University College of Medicine, Seoul, Republic of Korea

    Myung Gyu Song

Authors
  1. Deok Gie Kim
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  2. Yoon Young Choi
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  3. Ji Yeong An
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  4. In Gyu Kwon
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  5. In Cho
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  6. Yoo Min Kim
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  7. Jung Min Bae
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  8. Myung Gyu Song
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  9. Sung Hoon Noh
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Corresponding author

Correspondence to Ji Yeong An.

Additional information

D. G. Kim and Y. Y. Choi contributed equally to this work.

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Kim, D.G., Choi, Y.Y., An, J.Y. et al. Comparing the short-term outcomes of totally intracorporeal gastroduodenostomy with extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer: a single surgeon’s experience and a rapid systematic review with meta-analysis. Surg Endosc 27, 3153–3161 (2013). https://doi.org/10.1007/s00464-013-2869-8

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  • DOI: https://doi.org/10.1007/s00464-013-2869-8

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