Comparison of Postoperative Pain in Laparoscopy-Assisted Distal Gastrectomy and Totally Laparoscopic Distal Gastrectomy by Location of Mini-Laparotomy Site

PURPOSE: We aimed to evaluate the clinical outcomes and determine the degree of postoperative pain associated with the location of mini-laparotomy sites in gastric cancer patients who underwent laparoscopic-assisted distal gastrectomy (LADG) or totally laparoscopic distal gastrectomy (TLDG). METHODS: Between November 2011 and December 2016, 153 patients who underwent surgery for gastric cancer at Kyung Hee University Hospital at Gangdong were reviewed retrospectively. We divided the patients into LADG with epigastric incision, TLDG with umbilical incision (TLDG_U), and TLDG with Pfannenstiel incision (TLDG_P) groups according to the location of incision for anastomosis and specimen removal. There were 37 cases in the LADG group, 85 in the TLDG_U group, and 31 in the TLDG_P group. The clinical characteristics, numeric rating scale (NRS) scores, and postoperative analgesic usage for 7 days of the three groups were compared. RESULTS: There was no statistically significant difference in clinical characteristics including age, sex, body mass index (BMI), TNM staging, and complications among the three groups. There was no significant difference in the amount of total analgesics received; however, the TLDG_P group received more analgesics (5.26±5.053, p=0.412) during the first 7 postoperative days. The TLDG_P group showed higher NRS scores on postoperative days 0, 2, 3, 4, and 5 (p=0.04, 0.001, 0.003, 0.006, and 0.002 respectively). CONCLUSION: Laparoscopic distal gastrectomy can be performed through various incision sites for increasing the safety of mini-laparotomy. However, a Pfannenstiel incision was shown to be more painful than other incisions.