Role of Laparoscopic Management for Postgastrectomy Complications

摘要

Background: The role of laparoscopy for the management of various types of postgastrectomy complications has not yet been well studied. We describe laparoscopic management of postgastrectomy complications and present a comparison between laparoscopy and other modalities in terms of basic characteristics and postreoperation clinical course. Materials and Methods: We studied 82 patients with postgastrectomy complications (Clavien–Dindo grade ≥IIIa) at a single institution between April 2009 and November 2016. We excluded 15 patients with pulmonary, wound-related, and/or ambiguous complications and eventually studied 67 patients who were divided into nonoperative intervention (NI), laparoscopic reoperation (LR), and open reoperation (OR) groups. Clinicopathological characteristics and surgical outcomes were compared. Results: Among the 67 patients studied, 31, 21, and 15 belonged to the NI, LR, and OR groups, respectively. Complications included bleeding in 29, leakage in 26, intestinal obstruction in 6, and intra-abdominal abscesses in 6 patients. Among the 21 patients in the LR group, bleeding was reported in 11, leakage in 5, intestinal obstruction in 3, and intra-abdominal abscesses in 2 patients. No significant differences were observed between the groups in terms of clinicopathological characteristics. Regarding surgical outcomes, the NI and LR groups required a mean of 11 days before discharge—a period that was significantly shorter than that required by the OR group (20.5 ± 14.3 days). All patients belonging to the LR group were successfully treated and discharged 11.3 ± 6.0 days after reoperation. Conclusions: Laparoscopic management of postgastrectomy complications is a safe and effective procedure primarily because it is associated with a smaller incision, more rapid recovery, and shorter length of hospitalization than that associated with an open laparotomy.