The Influence of Operative Approach on Food Retention after Open and Laparoscopy-Assisted Distal Gastrectomy (LADG) for Gastric Cancer

Purpose: Laparoscopy-assisted distal gastrectomy (LADG) has gained wide acceptance for minimally invasive treatment of early gastric cancer (EGC). The aim of this study was to see the relationship between the operative approach of a distal subtotal gastrectomy and food retention of the remnant stomach. Methods: A retrospective review of the records of 321 consecutive patients with gastric cancer who underwent a distal subtotal gastrectomy between 2001 and 2008 was conducted. A total of 233 patients who revisited the same surgeon’s outpatient clinic and received regular endoscopic examination using the same protocol were finally included in this study. Reconstruction was performed using the Billroth I procedure. Mechanical-stapled anastomosis (MSA) was performed in 112 patients and conventional hand-sutured anastomosis (HA) was performed in 121 patients. Results: According to results of multivariate analysis, the anastomosis method (MSA) was the only independent risk factor for accumulation of food residue. At six and 12 months after surgery, the incidence of food retention was higher in patients who had undergone MSA (22.3%, 13.4%) than in those who had undergone HA (9.1%, 2.5%) (p=0.006, p=0.002, respectively). However, the incidence of food residue at 24 months after surgery did not differ statistically between MSA and HA (p=0.266). Conclusion: Our results showed that the laparoscopic approach was not influenced on the accumulation of food residue. Mechanical-stapled anastomosis was the only independent risk factor for food retention. During the early postoperative period, although more food retention was observed in patients who underwent MSA than in those who underwent HA, in the long term, this anastomosis method did not influence food retention after a distal gastrectomy.