Reconstruction after Laparoscopic Distal Gastrectomy

Laparoscopy-assisted distal gastrectomy (LADG) has advanced much in the past 10 years in the eastern countries, due to the high gastric cancer incidences. Reconstruction is the major hurdle for perfect laparoscopic distal gastrectomy (LDG). Initially, hand-associ- ated or small incisional open laparotomy reconstruction, the so-called associated operation, was performed. A full laparoscopic operation is much better for the patient—small wound, less pain, and quick recovery. Several reconstruction methods have been developed by experts during more than 10 years. The question of what method is the best after distal gastrectomy is still controversial. This chapter focuses on the reconstruction methods in the total laparoscopy distal gastrectomy (LDG) operation, explains the merits and demerits of several methods, and introduces our original method, named augmented rectangle technique (ART).