Page 24 - Read Online
P. 24

Ohmura et al. Mini-invasive Surg 2019;3:4  I  http://dx.doi.org/10.20517/2574-1225.2018.69                                      Page 9 of 13


                                A  Length of the grater curvature
                                   (mm)
                                   290
                                                                        r  = 0.45, P  < 0.01
                                   270
                                   250
                                   230
                                   210
                                   190
                                   170
                                   150
                                      15                   20                   25                    30                   35
                                                            BMI                  (kg/m )
                                                                                      2
                                B  Length of the grater curvature
                                   (mm)
                                   290                                r  = 0.07, P  = 0.47

                                   270
                                   250
                                   230
                                   210
                                   190
                                   170
                                   150
                                       15                   20                   25                    30                   35
                                                                                      2
                                                            BMI                   (kg/m )
               Figure 5. Simple linear regression analyses between BMI and the length of the greater curvature of resected stomach. The length of the
               greater curvature weakly correlated with BMI in the extracorporeal total hand-sewn group (A); while there was no correlation between
               BMI and length of the greater curvature in the intracorporeal hemi-hand-sewn group (B)

               Table 2. Size of resected specimen
                                                  EC-THS (n = 85)     IC-HHS (n = 110)       P value
               Maximum tumor, mean ± SD (mm)        31.6 ± 15.5          35.6 ± 28.1        P = 0.20
               Greater curvature, mean ± SD (mm)    214.6 ± 21.7         228.7 ± 19.7       P < 0.01
               Lesser curvature, mean ± SD (mm)     148.7 ± 17.6         149.2 ± 18.3       P = 0.50
               Duodenum, mean ± SD (mm)             14.7 ± 3.6           14.1 ± 4.0         P = 0.22
               Proximal margin, mean ± SD (mm)      53.4 ± 32.4          54.1 ± 32.5        P = 0.88
               Distal margin, mean ± SD (mm)        77.1 ± 35.7          78.5 ± 39.8        P = 0.87
               SD: standard deviation; EC-THS: extracorporeal-total hand-sewn group; IC-HHS: intracorporeal-hemi-hand-sewn group

               other hand, intracorporeal B-I reconstruction by means of open surgery requires considerable advanced
               technical skill. Therefore, several procedures for B-I intracorporeal gastroduodenostomies specific to
                                                                                    [16]
               laparoscopic surgery have been reported, such as IC-DS gastroduodenostomy , triangulation stapling
                        [22]
                                                                 [25]
               technique , book binding technique [23,24] , overlap method , and double-stapling technique with circular
               stapler. Sufficient blood supply of digestive tracts, absence of excessive tension, well-apposed tissues at the
               anastomotic site, and appropriate anastomotic techniques are critically important factors for successful and
               safe anastomosis. In terms of blood supply and tension between the reconstructing digestive tract, hemi-
                                                                                               [26]
               double stapling technique with circular stapler is the best procedure for gastroduodenostomy . However,
   19   20   21   22   23   24   25   26   27   28   29