Techniques and complications of laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer.

AIM: Recently, LADG has become a viable alternative for the treatment of patients with early gastric cancer. Surgeons who are seeking to undertake, or currently practicing LADG, are concerned about unpredictable intraoperative events that occur during LADG. The aims of this study were to investigate intraoperative and postoperative complications in laparoscopy-assisted distal gastrectomy (LADG) with more than D1+beta lymphadenectomy for gastric cancer. MATERIALS AND METHODS: Of 219 patients who underwent laparoscopy-assisted gastrectomy for gastric cancer by a single surgeon between April 2003 and January 2006, 128 patients were enrolled in this study. The operative procedure was divided into five steps. Various intraoperative complications, such as bleeding and perigastric organ injuries, that occurred during different operative steps were investigated by reviewing videotapes. RESULTS: A total of 839 events of bleeding were encountered during the procedure with a mean of 6.6 per patient. The mean number of bleeding during each step was significantly different and more bleedings occurred during steps II and IV (P<0.0001). Sixteen cases of complications other than bleeding occurred in 15 patients (11.7%), and they were all managed properly without conversion or reoperation. Postoperative morbidity and mortality rates were 15.6 and 0.7%, respectively. CONCLUSION: LADG with more than D1+beta lymphadenectomy is a technically feasible and acceptable surgical modality for gastric cancer. Intraoperative bleeding was found to be the most common complication during LADG for gastric cancer, and more bleedings occurred during steps II and IV.