2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
cation rate for SN was 100% (32/32), and the mean number of
SN was 5.2?}3.8 (1~13 SN). Five of the 32 patients had lymph
node metastasis. The sensitivity (5/5) and diagnostic accuracy
(32/32) were both 100%. CONCLUSION: By the use of IRLS
observation in laparoscopic surgery, the same sensitivity was
obtained in SN identification as with infrared ray electronic
endoscopy; it was not necessary to darken the operating
room, and the operation of the IRLS as well as observation
with IRLS were easier than those in open surgery. The IRLS
seems to be a useful tool for laparoscopic identification of SN
for early gastric cancer.
P267–Esophageal/Gastric Surgery
LAPAROSCOPY- ASSISTED TOTAL GASTRECTOMY FOR GAS-
TRIC CANCER, Kazuyuki Okada MD, Syuji Takiguchi
MD,Mitsugu Sekimoto MD,Hiroshi Miyata MD,Yoshiyuki
Fujiwara MD,Takushi Yasuda MD,Yuichiro Doki MD,Morito
Monden MD, Department surgery and clinical oncology,
Graduate school of medicine, Osaka university
[Purpose] With the development of related instruments and
techniques, laparoscopic gastrectomy which include partial
gastrectomy and distal gastrectomy, has come to be applied to
the treatment of?@gastric cancer as a minimally invasive surgery.
However, laparoscopy- assisted total and proximal gastrectomy
are not so common, and they are also considered as
the challenging procedures. It is the most major reasons that
esophagojejunostomy and esophagogastrostomy under the
laparoscopy have technical difficulties. So, we will report
about our technique of laparoscopy- assisted total gastrectomy,
especially about esophagojejunostomy by using semi
automatic suturing device?iEndostitch?j. [Method] From
September 2001 to March 2004, laparoscopy- assisted total
gastrectomy with lymph node dissection was performed on 14
patients in our hospital. They were also divided into two
groups by the extent of lymph node dissection based on the
preoperative clinical stage. One was laparoscopic D1+ beta
lymph node dissection for 11 patients with T1N0, the other
was hand- assisted laparoscopic D2 lymph node dissection for
3 patients with T1N1 or T2N0. Hand- assisted method was performed
for splenectomy and the dissection of NO.10 and
NO.11d lymph nodes. The way of laparoscopic anvil- head fixation
on esophagojejunostomy is as follows. Firstly, the tip of
the suture of Endostitch was brought outside the body using
the Endoclose instrument. After about ten encircling pursestring
sutures were performed by Endostitch, an anvil-head
was placed laparoscopically with supporting the esophageal
wall at three points. When the intracorporeal ligation using
Endostitch was performed, it was possible to get ligation with
a sufficient degree of tension by pulling the suture placed
through the abdominal wall extracorporeally. [Result] The
mean operating time and blood loss on the cases of laparoscopic
D1+ beta lymph node dissection were 287 minutes and
155.4 ml. On the other hand, those were 364 minutes and
583.3 ml respectively on the cases of hand- assisted laparoscopic
D2 lymph node dissection. There was no major postoperative
complication and no recurrent cases in both procedures.
It was indicated that our technique of esophagojejunostomy
was suitable and laparoscopy- assisted total gastrectomy
was a feasible procedure for gastric cancer.
P268–Esophageal/Gastric Surgery
LAPAROSCOPIC WEDGE GASTRECTOMY ESOPHAGEAL
LENGTHENING PROCEDURE: CLINICAL AND PHYSIOLOGICAL
FOLLOW-UP, Allan Okrainec MD, Cliff Sample MD,Herawaty
Sebajang MD,Mehran Anvari PhD, Centre for Minimal Access
Surgery, McMaster University, Hamilton Ontario Canada
Background: Various methods of Collis gastroplasty have been
described to lengthen the esophagus. In this series of 8
patients, we describe early outcomes following a laparoscopic
wedge gastrectomy (LWG) esophageal lengthening procedure.
Methods: Between January 2004 and August 2004, patients
with PEH were assessed pre-operatively with symptom scores
(SF-36, GERD score), upper endoscopy, barium swallow, 24-hr
pH monitoring, and esophageal manometry. Intra-operatively,
after reduction of the PEH and mobilization of the esophagus,
patients with less than 2 cm of intraabdominal esophagus,
underwent LWG. A 52 French bougie was advanced and the
196 http://www.sages.org/
wedge gastrectomy was performed using a 45mm endo-GIA
linear-cutting stapler.
Results: Eight patients (5M:3F) with a mean age of 66.9 ± 11.6
years underwent LWG. Six patients (75%) had GERD; seven
patients (87.5%) had PEH (6 type III, 1 type IV); six (75%) had
organoaxial volvulus of the stomach; two patients (25%) had
previously failed fundoplications; three patients (37.5%) had
Barrett?s esophagus. Mean O.R. time was 188.1 ± 51.9 min.
Mean LOS was 3.9 ± 2.0 days. Mean time to start of oral diet
was 1.25 ± 0.7 days. All patients had a gastrograffin swallow
on POD one. All were normal except one which showed a
small stricture at the level of the diaphragm. The only minor
complication was post-op dysphagia in this same patient. This
resolved without dilatation. There were no major complications.
Objective evaluation with upper endoscopy, 24-h. pH
recording and manometry is planned for our patients at 6
months.
Conclusion: LWG esophageal lengthening procedure is a safe
technique for dealing with a shortened esophagus. Long term
clinical and physiological follow-up are still needed. Our six
month follow-up data will be available at the time of presentation.
P269–Esophageal/Gastric Surgery
LAPAROSCOPIC INTRAGASTRIC SURGERY UNDER CARBON
DIOXIDE PNEUMOSTOMACH, Takeshi Omori MD, Kiyokazu
Nakajima PhD,Toshirou Nishida PhD,Syunnji Endo MD,Eiji
Taniguchi* PhD,Shuichi Ohashi* PhD,Toshinori Ito PhD,Hikaru
Matsuda PhD, Department of Surgery, Osaka University
Graduate School of Medicine. Osaka, Japan *Department of
Surgery, Osaka Central Hospital, Osaka, Japan
Background: Laparoscopic intragastric surgery (LIGS) requires
pneumostomach to maintain exposure and working space in
the stomach. The pneumostomach is originally created by
atmospheric air insufflation through flexible gastrointestinal
endoscopy. The insufflated air, however, often migrates downwards
without duodenal clamping and causes excessive and
prolonged bowel distention. The distention of downstream
bowel complicates visualization of conclusion laparoscopy in
LIGS, and may further lead to postoperative abdominal pain
and bloating. Carbon dioxide (CO2), with its faster absorption
than air, can attenuate downstream bowel distention when
used to establish pneumostomach. The objectives of this study
were to evaluate feasibility, safety and effectiveness of CO2
pneumostomach in LIGS. To our knowledge, this is the first
clinical series of CO2 pneumostomach. Methods: We have performed
15 LIGSs under CO2 pneumostomach (01/1997 to
08/2004): 8 males, 7 females; mean age of 60.9 years. The
stomach was insufflated with CO2 via automatic surgical insufflator
up to 8 mmHg of intraluminal pressure. No duodenal
clamping was employed prior to insufflation. Cardiopulmonary
parameters e.g. heart rate, body temperature, end tidal CO2,
were prospectively registered and retrospectively analyzed.
Minute volume was positively adjusted when indicated. The
degree and extent of bowel distention was assessed by conclusion
laparoscopy and the amount of intestinal gas was evaluated
by postoperative plain abdominal radiograph. Results:
LIGS was completed in all 15 cases with mean intragastric
insufflation time of 100 minutes. CO2 pneumostomach provided
good and constant surgical exposure with sufficient working
space. No adverse effect of intragastric CO2 insufflation
was observed on cardiopulmonary function, with minimal
hyperventilation (i.e. 20% increase of minute volume). Even
without duodenal clamping, the insufflated small bowel loops
already shrank at the time of conclusion laparoscopy. Fair
residual gas was documented radiologically in 2 cases, whereas
only faint in remaining 13 cases. No patients showed
abdominal pain/bloating postoperatively and no consequences
related to CO2 pneumostomach were encountered in the
series. Conclusions: CO2 pneumostomach is feasible and safe
alternative and potentially effective for LIGS, by eliminating
need for prior duodenal clamping and minimizing bowel distention.
P270–Esophageal/Gastric Surgery
LAPROSCOPIC ASSISTED TOTAL GASTRECTOMY, Shailesh P
Puntambekar MD, Rajendra S Jathar MD,Suresh M Ranka MD,
King Edward Memorial