Current Status of Metabolic and Bariatric Surgery in Daejeon/Chungcheong Area Dong-Wook Kim, Dae Hoon Kim, Jeong Goo Kim, Myoung Won Son, Geum Jong Song, Seong-il Oh, Han Mo Yoo, Moon-Soo Lee, Sang Kuon Lee, Sang-Il Lee, Ye Seob Jee, Si Eun Hwang, Sang Eok Lee Departments of Surgery, Dankook University Hospital, Cheonan, Chungbuk National University Hospital, Cheongju, The Catholic University of Korea, Daejeon St. Mary’s Hospital, Daejeon, Soonchunhyang University Cheonan Hospital, Cheonan, Cheongju St. Mary’s Hospital, Cheongju, Eulji University Hospital, Chungnam National University Hospital, Daejeon Sun Hospital, Konyang University Hospital, Daejeon, Korea

Purpose: The purpose of this study was to compare Roux-en-Y (R-Y) reconstruction with Billroth-II (B-II) reconstruction after a totally laparoscopic distal gastrectomy (TLDG). Methods: Eighty-one consecutive TLDG procedures were performed by a single surgeon and subsequently examined. Postoperative outcomes, clinicopathologic features, and postoperative endoscopic findings between the 2 groups were evaluated and compared. Results: The mean operation time was not significantly higher in the R-Y than in the B-II group (P=0.396). Postoperative hospital stay was longer in the R-Y than in the B-II group (P=0.037). The severities of gastritis and bile reflux were reduced significantly in the R-Y group as compared with that in the B-II group (P<0.001). There was no significant difference in the amount of residual food between the 2 groups. Conclusions: R-Y reconstruction after TLDG appears to be a safe and feasible procedure, and is associated with a reduced severity of gastritis and bile reflux in the remnant stomach.

The purpose of this study was to compare Roux-en-Y (R-Y) reconstruction with Billroth-II (B-II) reconstruction after a totally laparoscopic distal gastrectomy (TLDG).Eighty-one consecutive TLDG procedures were performed by a single surgeon and subsequently examined. Postoperative outcomes, clinicopathologic features, and postoperative endoscopic findings between the 2 groups were evaluated and compared.The mean operation time was not significantly higher in the R-Y than in the B-II group (P=0.396). Postoperative hospital stay was longer in the R-Y than in the B-II group (P=0.037). The severities of gastritis and bile reflux were reduced significantly in the R-Y group as compared with that in the B-II group (P<0.001). There was no significant difference in the amount of residual food between the 2 groups.R-Y reconstruction after TLDG appears to be a safe and feasible procedure, and is associated with a reduced severity of gastritis and bile reflux in the remnant stomach.

BACKGROUND:This study was designed to compare short-term laparoscopic total gastrectomy (LTG) with open total gastrectomy (OTG) outcomes in gastric cancer.METHODS:Seventy patients who underwent total gastrectomy via LTG or OTG were included. All cases were matched for stage, age, and sex by means of statistically generated selection of all gastrectomies performed during the same period.RESULTS:Although the operation time was not longer for LTG, the time required for esophagojejunostomy was significantly longer in LTG than in OTG (43 vs 14 min, P < .05). The incidence of anastomotic complications was higher in the LTG group as well.CONCLUSIONS:Postoperative complications such as anastomotic leakage and stenosis were observed more frequently in LTG. To improve the safety of esophagojejunostomy in LTG, technical innovations should be pursued.

Purpose: The aim of this study was to introduce our technique and evaluate the technical efficacy of Roux-en Y (RY) reconstruction after total laparoscopic distal gastrectomy (TLDG). Methods: We performed TLDG using our own method of RY-type anastomosis in a total of 38 consecutive patients with gastric adenocarcinomas and evaluated the techniques and postoperative outcomes. Results: The mean operative time was 144.5±22.4 minutes, including reconstruction time, which was 26.2±3.5 minutes. Most patients were of pathologic stage IA (76.3%) or IB (10.5%), 3 patients were of stage II, and 2 were of stage IIIA. The length of postoperative hospital stay was 8.3±3.3 days (range, 5 to 20 d). Two cases required reoperation because of internal herniation. According to our endoscopic observation, bile reflux into the gastric remnant stump was not found. Conclusions: TLDG with RY reconstruction is technically feasible in gastric cancer patients.

Background Even for expert surgeons, esophagojejunostomy after laparoscopic total gastrectomy (LTG) is not always easy to perform. Herein, we compare various types of esophagojejunostomy in terms of the technical aspects and postoperative outcomes. Methods A total of 48 patients underwent LTG for gastric cancer by the same surgeon. Four types of intracorporeal esophagojejunostomies have been applied after LTG: type A, a conventional anvil head method; type B, an OrVil™ system method; type C, a hemi-double stapling technique with anvil head; and type D, side-to-side esophagojejunostomy with linear stapler. We describe and review these types of esophagojejunostomy using a step-by-step approach. Results The mean reconstruction times were longer for types A and B than for types C and D ( p < 0.05). In terms of complications, there were five cases (10.4 %) of anastomosis leakage, which was more common in types A and B: two cases in each of type A and B and one case in type C. Moreover, anastomosis stricture requiring intervention was more common in types A and B ( p < 0.05). Conclusions To date, there are no reliable reconstruction methods after LTG. Therefore, special care is needed to prevent postoperative complication regardless of methods; also, technical innovations to support development of the safest methods of esophagojejunostomy are warranted.

We assessed the ability of positron emission tomography–computed tomography (PET/CT) to detect synchronous colonic pathology and determined the significance of 18F-fluorodeoxyglucose (18F-FDG) activity in the colon of gastric cancer patients.

Background and Objectives This study examined the surgical outcome of non-curative resection in elderly patients with gastric cancer. Methods The study reviewed 278 patients who underwent non-curative resection for advanced gastric cancer. The clinicopathological features of elderly patients (=75 years, n?=?257) and younger patients (<75 years, n?=?21) were compared. Results Although no difference was observed in terms of preoperative performance, there were distinct differences in terms of albumin level, presence of symptoms, and the rate of comorbidities between the two groups. The postoperative morbidity and mortality rate did not differ between the two groups. Age, preoperative performance status, preoperative transfusion, and presence of comorbidity were not independent predictors of postoperative complications. However, the extent of gastric resection and combined resection were closely related to postoperative complications in patients with non-curative gastrectomy. Conclusions In a setting of non-curative resection for gastric cancer, age was not a limiting factor. Rather, the risk of postoperative morbidity should be considered carefully in total gastrectomy and combined resection. J. Surg. Oncol. 2012; 106:753756. (c) 2012 Wiley Periodicals, Inc.