LAPAROSCOPIC BILLROTH-II DISTAL SUBTOTAL GASTRECTOMY WITH GASTRIC STUMP SUSPENSION FOR GASTRIC MALIGNANCIES

BACKGROUND: Laparoscopy has played an ill-defined role as a diagnostic tool for the staging of gastric and other intra-abdominal malignancie s for a long time, The widespread use of the laparoscopic approach for the treatment of some benign abdominal diseases, such as biliary lith iasis and gastroesophageal reflux disease, has encouraged the authors toward its use in the treatment of malignant gastric neoplasms, both f or palliation and for curative surgery. METHODS: A five-puncture techn ique for laparoscopic distal subtotal gastrectomy, omentectomy, divisi on of the left gastric artery at its origin, and D1 lymph node dissect ion has been developed by the authors, and is fully depicted and discu ssed, Reconstruction of digestive continuity is achieved through a pos terior transmesocolic side-to-side stapled gastrojejunostomy, facilita ted by an original method of suspension of the gastric stump to the an terior abdominal wall, RESULTS: In a preliminary series of 10 cases, t his technique was demonstrated to be safe, showing no mortality, and h aving morbidity rates comparable to those of open surgery, CONCLUSION: The operation is effective, with a mean number of resected nodes comp arable to that usually achieved in open surgery, and no cases of conve rsion to laparotomy.