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> Completely laparoscopic total and partial gastrectomy for benign and malignant diseases : a single institute’s prospective analysis.

Background: Laparoscopic surgery for gastrointestinal benign disease has gained worldwide acceptance, while totally laparoscopic surgery for malignant diseases remains controversial. The purposes of this study were to examine prospectively our experience with laparoscopic gastric resections, to evaluate the surgical outcome and to discuss the role of these procedures in the treatment of benign and malignant diseases of the stomach. To the best of our knowledge, this is the largest prospective study of totally laparoscopic total and partial gastrectomies in western countries.

Study design: Thirty three patients who underwent totally laparoscopic gastric resection between April 1995 and January 2004, were studied prospectively. Eight patients underwent laparoscopic total gastrectomy and twenty five patients had laparoscopic partial gastrectomy. There were 21 females and 12 males with a mean age of 71 ± 10 years.

Results : Twenty one patients (63.6%) were operated on due to malignant diseases and twelve patients (36.4%) had benign lesions. Conversion to laparotomy was not required in any case. Mean operative time was 138±40 minutes and mean blood loss was 58±85 mL. There were no major intraoperative complications except for one splenectomy and there were no perioperative deaths. Two postoperative complications occured: One patient developed an intraperitoneal abscess with a small duodenal fistula after total gastrectomy and was treated by peritoneal lavage and drain placement. The other patient after subtotal gastrectomy developed delayed gastric emptying and was managed conservatively. Mean ambulation time and mean hospital stay were 2.3±0.7 days and 14.6±5 days, respectively. All resected margins were tumor free. The mean number of retrieved lymph nodes for the malignant lesions was 22 ± 12 (range, 10-53).

Conclusions : this prospective trial demonstrated that totally laparoscopic total and partial gastric resections had good results and were proven as feasible and safe procedures. In addition, we concluded that the totally laparoscopic approach for early and advanced gastric cancer can obtain adequate margins and follow oncologic principles

Keywords : Laparoscopy – Gastric surgery – Total gastrectomy- Partial gastrectomy- Early gastric cancer – Advanced gastric cancer.

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