Laparoscopic Billroth II Gastrectomy.

The first successful totally intra-abdominal laparoscopic Billroth II gastrectomy was performed on February 10, 1992, by our group in Singapore. The patient was a 76-year-old Chinese man with a 2-year history of gastric ulcer, which presented with bleeding. The operation took 4 hours and consumed 17 ENDO GIA (Auto Suture, USSC, Norwalk, CT) staplers. The benefits of this minimally invasive approach were clearly evident. The patient was walking on the first postoperative day, taking liquids on the third, solids on the fourth, and was discharged on the fourth postoperative day. The operation was subsequently emulated by surgeons in about a dozen countries. The description in this chapter is a modification of the original technique, using the improved instrumentation that is now available.