LAPAROSCOPIC GASTRECTOMY VERSUS OPEN GASTRECTOMY FOR CARCINOMA STOMACH: A PROSPECTIVE, OBSERVATIONAL STUDY FROM A THIRD WORLD COUNTRY
Prof. (Dr.) Iqbal Saleem Mir, Dr. Younis Ahmad Dar, Dr. Ranjeet Singh, Dr. Younis Bashir, Dr. Arshad Rashid*, Dr. Ishtiyaq Hussain and Dr. Ayaz Rashid
Background: Minimally invasive gastrectomy was introduced in 1993 and aimed at reducing surgical trauma and as a consequence lowering morbidity and mortality. Several systematic reviews and meta-analyses have shown an advantage in short term outcomes of laparoscopic distal and total gastrectomy compared to open procedures. Oncologic outcomes are similar on the short term. The aim of the present study was to assess the feasibility and safety of laparoscopic gastrectomy. Methods: Enrolled patients were informed and included at the surgical outpatient department. Performance Statusof the patients was assessed. The Dutch guideline on gastric cancer was used to guide the preoperative evaluation of patients. Results: Laparoscopic gastrectomy was done in 17 (48.6%) patients while as open gastrectomy was done in 18 (51.4%) patients. The mean operative time in laparoscopic gastrectomy group was 262.06+23.456 minutes in comparison to 175.50+23.147 minutes in open gastrectomy group (p < 0.01). The mean intraoperative bleeding in open gastrectomy group was 271.11+63.929 compared to 162.06+38.893 in laparoscopic gastrectomy group (p < 0.01). When compared on duration of postoperative hospital stay the difference was statistically significant with mean 8.00+0.866 days hospital stay in laparoscopic group in comparison with 11.39+1.852 days in open gastrectomy group. Postoperative morbidity was seen in 4 patients in laparoscopic gastrectomy including anastomotic leak in 1 (5.8%)), diarrhea in 1 (5.8%), gastric stasis and vomiting in 1 (5.8%) and respiratory infection in 1 (5.8%) patient. Postoperative morbidity was seen in 5 patients in open gastrectomy group that included gastric stasis and vomiting in 1 (5.5%), respiratory infection in 1 (5.5%) patient, surgical site infection in 2 (11.11%) patients and urinary difficulty in 1 (5.5%) patient. Conclusion: The study demonstrates benefits of laparoscopic surgery in terms less intraoperative blood loss, quicker postoperative recovery and reduced postoperative morbidity at the cost of longer operative time.
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