Totally Laparoscopic Distal Gastrectomy with ROUX-EN-Y Reconstruction for Treatment of Duodenal Ulcer Obstruction

Min Gyu Kim; Beom Su Kim; Tae Hwan Kim; Kap Choong Kim; Jeong Hwan Yook; Sung Tae Oh; Byung Sik Kim

doi:10.5230/jgc.2010.10.2.75

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Kim, Kim, Kim, Kim, Yook, Oh, and Kim: Totally Laparoscopic Distal Gastrectomy with ROUX-EN-Y Reconstruction for Treatment of Duodenal Ulcer Obstruction

Case Report

Journal of Gastric Cancer

Journal of Gastric Cancer 2010; 10(2): 75-78.

Published online: 30 June 2010

DOI: https://doi.org/10.5230/jgc.2010.10.2.75

Totally Laparoscopic Distal Gastrectomy with ROUX-EN-Y Reconstruction for Treatment of Duodenal Ulcer Obstruction

Min Gyu Kim, Beom Su Kim, Tae Hwan Kim, Kap Choong Kim, Jeong Hwan Yook, Sung Tae Oh, Byung Sik Kim

Department of Gastric Surgery, Asan Medical Center, Ulsan University, Seoul, Korea.

Correspondence to: Byung Sik Kim. Department of Gastric Surgery, Asan Medical Center, Ulsan University, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3491, Fax: +82-2-474-9027, bskim@amc.seoul.kr

Received 1 April 2010 Accepted 10 June 2010

Abstract

Because of advancement of medical treatment, surgical management of gastric or duodenal ulcer was indicated for treatment of perforation, massive hemorrhage and obstruction. The distal gastrectomy including ulcer was known as principle method of duodenal ulcer obstruction, but actually many surgeons have performed only bypass surgery for the difficulty of formation of duodenal stump. In our case, 61-year-old male with repetitive duodenal ulcer obstruction transferred with obstruction due to deformities and inflammations of duodenal ulcer. We had performed totally laparoscopic distal gastrectomy with ROUX-EN-Y reconstruction using the clear visibility of laparoscopy and fine dissections of harmonic scalpel. The patient started soft diet on postoperative day 5 and discharged on postoperative day 8. He returned to work after discharging immediately.

Keywords: Totally laparoscopic gastrectomy, Duodenal ulcer obstruction

Figures and Tables

Fig. 1

Endoscopic findings of deformed duodenal bulb and gastric outlet obstruction.

Fig. 2

CT findings of deformed duodenal bulb and distended stomach.

Fig. 3

(A) Edematous stomach is accompanied by gastric outlet obstruction. (B) After the dissection of posterior of duodenal bulb. (C) Duodenal stump. (D) State of gastrojejunostomy using the endoscopic linear staplers.

Fig. 4

Postoperative UGI finding.

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