**5. Discussion**

Our policy of reconstruction after distal gastrectomy is as follows. The first choice is Billroth I reconstruction. If the remnant stomach is too small for Billroth I reconstruction, we perform isoperistaltic RY reconstruction.

To date, we have used ART in 160 patients who underwent laparoscopic distal gastrectomy for stomach cancer between December 2013 and August 2017. These included 50 women and 110 men, with a mean age of 69.5 years and a mean body mass index (BMI) of 21.8. D1+ lymphadenectomy was performed in 81 patients, and D2 lymphadenectomy in 79 patients. The mean operation time was 227 minutes, and the mean blood loss volume was 47.3 mL. There were no intraoperative complications associated with reconstruction of the gastrointestinal tract, and none of the patients required conversion to open surgery. There were also no postoperative complications, such as anastomotic leakage or stenosis, associated with the reconstruction, and the mean postoperative hospital stay was 12 days (**Table 1**). Postoperative endoscopic examinations typically confirmed a large, elliptical anastomotic stoma (**Figure 21**).

> We performed antecolic isoperistaltic RY reconstruction in 52 consecutive patients who underwent laparoscopic gastrectomy for gastric cancer between April 2015 and December 2017. There were 32 women and 20 men, with a mean age of 70.4 years and mean body mass index of 22.3. D1+ lymphadenectomy was performed in 35 patients, and D2 lymphadenectomy in 17 patients. The mean operation time was 282 min, and the mean blood loss volume was 35.8 ml. All of the procedures were free of intraoperative complications. There were no postoperative complications, such as anastomotic leakage, intestinal obstruction, and duodenal stump leakage.

Reconstruction after Laparoscopic Distal Gastrectomy http://dx.doi.org/10.5772/intechopen.80630 57

Gastroenterology and Minimally Invasive Surgery, Juntendo University, Tokyo, Japan

[1] Fukunaga T, Ishibashi Y, et al. Augmented rectangle technique for Billroth I anastomosis in totally laparoscopic distal gastrectomy for gastric cancer. Surgical Endoscopy. 2018.

**Conflict of interest**

**Author details**

**References**

The authors declare no conflict of interest.

Satoshi Kanda\* and Tetsu Fukunaga

DOI: 10.1007/s00464-018-6266-1

\*Address all correspondence to: st-kanda@juntendo.ac.jp

**Figure 21.** Elliptical anastomotic stoma in postoperative examination.


**Table 1.** Characteristics of patients in whom ART-based anastomosis was performed (*n* = 160).

**Figure 21.** Elliptical anastomotic stoma in postoperative examination.

We performed antecolic isoperistaltic RY reconstruction in 52 consecutive patients who underwent laparoscopic gastrectomy for gastric cancer between April 2015 and December 2017. There were 32 women and 20 men, with a mean age of 70.4 years and mean body mass index of 22.3. D1+ lymphadenectomy was performed in 35 patients, and D2 lymphadenectomy in 17 patients. The mean operation time was 282 min, and the mean blood loss volume was 35.8 ml. All of the procedures were free of intraoperative complications. There were no postoperative complications, such as anastomotic leakage, intestinal obstruction, and duodenal stump leakage.
