Adachi and his colleagues are to be commended for their results in a large series of patients with early-stage gastric cancer who underwent laparoscopy-assisted Billroth I gastrectomy (LAG) or conventional open gastrectomy (COG). They demonstrated several advantages of LAG over COG, including less surgical trauma, less impaired nutrition, less pain, rapid return of gastrointestinal function, shorter hospital stay, no decrease in operative curability. This approach has been adopted by more than a few Japanese surgeons since the first case of LAG for early gastric cancer performed by the same authors in 1994. Briefly, LAG consists of 2 procedures: (1) laparoscopic approach under the pneumoperitoneum and (2) resection of the stomach followed by hand-sawn anastomosis through a minilaparotomy incision.
Inoue K. Laparoscopy-Assisted Billroth I Gastrectomy Compared With Conventional Open Gastrectomy—Invited Critique. Arch Surg. 2000;135(7):810. doi:10.1001/archsurg.135.7.810