근치적 위절제술 후 발생한 재발성 소장폐색증의 복강경 유착박리술

Abstract

Purpose: Laparoscopic surgery for patients with a prior history of a radical gastrectomy has been considered a relative contraindication because of severe adhesion. Many surgeons prefer conservative management for a small bowel obstruction (SBO) after gastric cancer surgery for fear that more adhesion could occur after an open adhesiolysis. We report our initial experience of laparoscopic adhesiolysis (LA) for recurrent SBO after gastric cancer surgery. Methods: This study performed a retrospective examination of 11 patients who underwent LA for a recurrent SBO after gastric cancer surgery between March 2005 and October 2005. Those with a SBO due to cancer recurrence or metastasis were excluded. Results: The mean duration for LA after the gastrectomy was 46 months (range: 8～166 months). In all patients, LA was successfully performed without an open conversion. The mean operation time was 77 minutes (range: 45～110 minutes). None of the patients required a bowel resection. There were two postoperative complications; one peritoneal abscess due to leakage and one wound infection, which were all treated conservatively. The mean hospital stay after surgery was 5.0 days (range: 4～7 days) for patients without complications. Ten out of 11 patients showed weight loss after the gastrectomy. The mean weight loss was 12.9 kg (range: 5～24 kg). Among those 11 patients, 9 patients gained weight with a mean increase of 3.7 kg (range: 1～6 kg), 1 patient lost weight due to periampullary cancer and 1 patient showed no change in weight. None of the patients suffered from a SBO after LA during the mean follow up period of 14 months (range: 9～16 months). Conclusion: Although the initial experience of LA was small, LA can be applied safely and effectively for patients with a recurrent SBO after a radical gastrectomy.