Laparoscopy-assisted gastrectomy for patients with earlier upper abdominal open surgery.

BACKGROUND: Laparoscopy-assisted gastrectomy (LAG) is increasingly carried out owing to its many advantages compared with conventional open gastrectomy. However, the question of whether LAG can be carried out safely in patients with earlier upper abdominal open surgery (EUAOS) remains unclear as laparoscopic adhesiotomy is technically difficult and time consuming.

METHODS: This study includes 32 consecutive cases with EUAOS who underwent a LAG in the Cancer Institute Hospital, between April 2005 and October 2008. Clinical data, including operation time, intraoperative bleeding, conversion rate, postoperative morbidity, and mortality, were examined to clarify the feasibility of carrying out LAG in patients with EUAOS.

RESULTS: Cholecystectomy was found to be the most common EUAOS. The total operation time was 256.5+/-11.3 minutes. Intraoperative bleeding was 80.7+/-19.2 mL. Conversion to open gastrectomy owing to severe adhesion occurred in 1 patient after right colectomy. Incidental intestinal perforation was observed in 1 patient although it could be repaired by laparoscopy and conversion was not required. There were no other intraoperative complications associated with adhesiotomy itself.

CONCLUSION: EUAOS itself is not a contraindication for LAG providing an experienced laparoscopic surgeon carries out the surgery.