Completely laparoscopic reconstruction following distal gastrectomy: what is the best method?

The number of laparoscopic gastrectomies (LG) has increased since the first LG was performed in the early 1990s (1,2). LG is widely accepted as an option for early gastric cancer in Korea and Japan, where many cases are diagnosed at an earlier stage because the numerous advantages of LG over open gastrectomy, such as less pain, earlier recovery, and improved cosmesis. Most early LG operations were “laparoscopy-assisted” distal gastrectomies, in which reconstruction was performed through a mini-laparotomy after gastrectomy had been completed laparoscopically (2). The laparoscopy-assisted technique has the advantage that surgeons can perform anastomosis in a similar fashion to that employed in open surgery. However, the procedure is still difficult in obese patients, or in cases requiring transection at a more proximal site, because of the limited work space, even under a larger laparotomy.