48. Comparison of laparoscopy - assisted gastrectomy and conventional open gastrectomy with the same operation equipment in early distal gastric cancer

Laparoscopy- assisted gastrectomy (LAG) for early distal gastric cancer was considered as a successful treatment with many advantages including smaller incision, lower blood loss, less pain, quick recovery, and short hospitalization. Because of the application of postoperative pain control and fast track surgery, some postoperative parameters, such as pain extent, time to oral intake, might become much more subjective. The operation time, blood loss, complication, and survival period remain as the relatively objective dada. The aim of this study was to evaluate the role of the harmonic scalpel of laparoscopic surgery in the blood loss, operation time, and complications. Altogether 45 patients diagnosed or suspected as early gastric cancer were divided into the laparoscopy- assisted distal gastrectomy (LADG) group and open distal gastrectomy (ODG) group. Harmonic scalpel was used in both the two groups, and the operation related data was compared. D2 gastretomy was performed in all of the patients, and Billroth I reconstruction was applied as 186 the first choice. According to the postoperative pathological results, 5 (5/22) in the LADG group and 9 (9/23) in the ODG group belong to the stage T2N0M0, and 4 (4/22) and 3 (3/23) were diagnosed as severe atypical hyperplasia. As to the results, only the difference of incision size and fee of hospitalization was found between the two groups (P<0.01). Other data, such as operation time, blood loss, the time to start oral intake, the number of harvested lymph nodes, complications, were not found different between the two groups. In this study, it is concluded that the clear operation field vision and small incision were the obvious advantage of LADG, and harmonic scalpel could help to reduce blood loss in both LADG and open gastrectomy. The main weak points of LADG were the difficulty of bleeding control if hemorrhage occur, and long time study curve.