Laparoscopic Gastrectomy in Patients With Previous Gastrectomy for Gastric Cancer: A Report of 17 Cases

Background: Laparoscopic gastrectomy (LAG) is increasingly used as a treatment for gastric cancer. However, it is contraindicated in patients with previous abdominal surgery, because of a higher risk of enteric injury, technical difficulties associated with adhesions, and longer operative times. The aim of this study was to assess the feasibility and clinical outcomes of LAG in patients who had previously undergone gastrectomy for gastric cancer. Materials and Methods: Between June 2008 and May 2012, we performed laparoscopic gastrectomies in 17 patients with remnant stomach cancer who had previously undergone open gastrectomy (10 patients) or LAG (7 patients) for early gastric cancer. We performed laparoscopic distal gastrectomies with Roux-en-Y gastrojejunostomy in 10 patients, and laparoscopic total gastrectomies in 7 patients. Results: None of the patients required conversion to open surgery or intraoperative transfusion. One patient with postoperative bleeding received a transfusion of 4 U of blood. There were 2 cases of serious postoperative complications: 1 internal herniation and 1 anastomosis leakage. One patient experienced tractitis at the trocar site. All patients had tumor-free resection margins, and there were no mortalities. Conclusion: LAG is a safe and realistic treatment for patients who have previously undergone gastrectomy, although it may be associated with an increased need for adhesiolysis and longer surgery times.