English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

Objective: TLDG (using the delta-shaped anastomosis) in the treatment of early gastric cancer is well accepted procedure in Japan. Conventional open Billorth-1 gastrectomy still mainly performed because of technical difficulties, especially intracorporeal gastroduodenostomy. Efficacy & feasibility of this procedure compared to open procedure to be elicited. Methods: Case-match retrospective study analysis of single institute’s experience in National Cancer Center East, Chipa, Japan. TLDG between Aug 2010 and Jul 2012. This procedure was compared with ODG as control between Aug 2008 and Jul 2010. 100 patients in each group, case-matched with staging and gender. Age for TLDG was 62.9 (± 11.1) and 65.4 (± 10.7) for ODG. M: F ratio in each group was 62:38. Early gastric cancer was considered for any patient with stage 1a, 1b & 2a. BMI for the first group was 22.5 (± 2.6) and second group 22.6 (± 3). Outcomes: Operation time, Blood loss, number of harvested lymph node, postoperative hospital stay, clinical pathway, postoperative complications. Results: No difference in the mean age, BMI, gender. Significant differences (P < 0.001) present between the two groups in blood loss, operation time & postoperative hospital stay. Estimated blood loss for TLDG group was 17.9 (± 21.8) ml and ODG was 234 (± 257.7) ml. Operation time for TLDG was 173 (± 30.5) min. and ODG was 204 (± 42.7). Post-operative hospital stay for TLDG was 8.5 (± 2.4) Days and for the ODG 11.2 (± 9.5). No conversion from laparoscopy to open surgery. No difference in complication rate between two groups. Conclusion: When skilled surgeon is available TLDG is more efficient and feasible compare to open distal gastrectomy. Significant reduction in blood loss, postoperative hospital stay & operation time can be gained in TLDG, and contribute to the patients’ quality of life. This study has limitations of retrospective study; therefore a prospective study should be conducted in near future. Correspondence to: Alhadhrami B, Royal Hospital, Muscat, Oman, Tel: +968 24 599000; E-mail: drbader85@hotmail.com Received: November 01, 2016; Accepted: November 09, 2016; Published: November 14, 2016 Introduction Stomach cancer still one of the common malignancies in the world, there were estimated to be 988,000 cases of stomach cancer diagnosed worldwide in 2008 [1]. Stomach Cancer still is one of the commonest cancers In Japan. Many Clinical Trials have shown that laparoscopic procedures compared to open procedures are safe and efficient. In Japan, Billroth-1 has been long preferred by many surgeons as reconstruction procedure after distal gastrectomy because of the physiological advantages of allowing food to pass through the duodenum [2-7]. Also, this type of reconstruction make the endoscopic surveillance much easier and faster. Total Laparoscopic Billroth-1 Gastrectomy (using the deltashaped anastomosis) in the treatment of early gastric cancer is becoming more popular & accepted procedure in Japan. However, in the world, conventional open Billorth-1 gastrectomy still mainly performed because of technical difficulties, especially intracorporeal gastroduodenostomy. Understanding the comparative effectiveness of laparoscopic and open approaches to resection of early-stage gastric cancer is an important issue in the surgical management of this condition [3]. Laparoscopic approach has developed tremendously especially with the improvement of new endoscopic staplers which make intracorporeal anastomosis feasible & much easier than before. Also, laparoscopic procedures have gained a vast reputation in the world where all fields of surgery had increase experience in the laparoscopic procedures & wellexperience laparoscopic surgeons too. The safety and efficacy of laparoscopic gastrectomy in the treatment of early gastric cancer have been demonstrated in many clinical studies [8-11]. Moreover, the benefits of laparoscopic procedures overweighed those of open procedures. Such as, less post-op pain & analgesia requirement, less blood loss, small wounds, faster recovery & earlier return to normal bowel function & oral intake, less hospital stay and early return to work. In this study, we studied Total Laparoscopic Distal gastrectomy(TLDG) compare to open distal gastrectomy procedures(ODG) where 100 cases from each group compared in different outcome measures. This study aimed to elicit the efficacy & the feasibility of this procedure compare to the open procedure to the world in presence of qualified laparoscopic surgeon. Alhadhrami B (2016) Total laparoscopic billroth-1(Distal) gastrectomy compare(TLDG) To open billroth-1 gastrectomy(ODG) in early gastric cancer Volume 2(6): 248-252 Clin Res Trials, 2016 doi: 10.15761/CRT.1000157 Methods In this single institute, namely East National Cancer centre data were collected retrospectively (after IRB approval i.e. Ethical approval in the institute by the HOD of gastric division. Prof. Takahiro Kinoshita) for all patients who underwent total laparoscopic distal (B1) gastrectomy (TLDG) for early gastric cancer between Aug 2010 and Jul 2012. This procedure was compared to open distal gastrectomy (ODG) of early gastric cancer patients in the same institute between Aug 2008 and Jul 2010. In each group, we reviewed 100 patients. The two groups were case matched in retrospective study analysis in which different parameters were compared. The main parameters of comparison in our study are Operation time, Blood loss, number of harvested lymph node, postoperative hospital stay, clinical pathway, postoperative complications. Each Group has same number of males and females respectively which is 62 males in each group and 38 females and the total of 200 patients. All patients between Aug 2008 and Jul 2010 were done as open procedures because of no availability of laparoscopic surgeon in gastric division in this institute. The other group underwent laparoscopic procedure when laparoscopic surgeon has become available. So, there was no randomization of the two groups as any patient with early gastric cancer was fit for laparoscopy procedure was included between Aug 2010 and Jul 2012. The inclusion criteria for early gastric cancer are satges Ia, Ib and IIa according to the Japanese classification of gastric carcinoma [12]. The patients stage also were matched in number and we chose same number of patients in each stage as it was available for comparison purposes. Also, other parameters were recorded for each patient such as: age, BMI & Clinical course of oral intake. The height and weight of patients were taken at the admission for surgery. The clinical course defined by 1st Postoperative day (POD) water, 3rd POD meals & 8th POD discharge from hospital. The meals were similar for all patients in both groups and it was started at 3rd day post-op and if patient had open bowel by passing flatus or motion. The patient was ready for discharge if he has no vomiting, abdominal pain or fever and capable to take up to 60% of the meal. All patients were fit for General anaesthesia with ASAI with no comorbidities. Preoperative assessment for all patients was by upper GI series, esophago gasteroendoscopy and Computerized tomography of the chest, the abdomen and Pelvis to stage the tumours according to the Japanese classification of gastric carcinoma. The type of reconstruction for the laparoscopic procedure was Intracorporeal gastroduodenostomy Delat-shaped anastomosis which was accomplished by linear staplers for all patients, this technique was which was introduced by Kanaya, et al. [13]. The open procedure gasteroduodenostomy anastomosis was accomplished by hand-sewn technique in the conventional method. Surgical technique total laparoscopic billroth-1 gastrectomy (using the delta-shaped anastomosis) The patient was placed in the modified lithotomy position. Where the surgeon stood at the right side of the patient, first assistant at the left side of the patient and the laparoscopist between the patient’s legs. Then the placement of five trocars, 12-mm trocar was inserted through an umbilical incision either with open technique or with optical port, and four other trocars (two 12-mm trocars and two 5-mm trocars) were placed under laparoscopic guidance as shown in the Figure 1. Laparoscopic procedures were performed under a pneumoperitoneum with 10 mmHg CO2. Mobilization of the stomach and end block systematic lymph node dissection was performed laparoscopically. The duodenum was transacted using an endoscopic linear stapler during lymph node dissection. Preservation of the vagal nerve system was not performed. The resection line of the stomach was determined with guidance from intraoperative gastroendoscopy, which recognized the marking clips that were placed preoperatively. The stomach was resected using an endoscopic linear stapler from the greater curvature site. The resected stomach was extracted via a 3-cm incision at the umbilical port (Figure 1), and the pneumoperitoneum was re-established. A small hole was made on the greater curvature side of the stomach and the posterior side of the duodenal stump. A 45-mm endoscopic linear stapler was introduced through a left lower port, and each jaw was inserted in the created holes. The stapler was closed and fired, thus attaching the posterior wall of the remnant stomach and the duodenum (Figure 2A). The entry hole was closed using two applications of the endoscopic. Linear stapler assisted by three stay sutures placed in advance (Figure 2B and 2C). The gastroduodenostomy was immersed in normal saline and tested for leaks by infusing air into the pouch lumen via a nasogastric tube and looking for escaping bubbles [3].