Woo Jin Hyung, et al. USA). The gastrojejunostomy was performed using interrupted 3-0 silk Lembert sutures for the outer layer and a running 3-0 polyglycolic suture for the transmural inner layer. Esophagojeju- nostomy was done using a circular stapler. Minilaparotomy was closed with continuous 1-0 polydioxanone sutures and the trocar sites were closed with 2-0 polydioxanone sutures. The subcutis and cutis were restored with interrupted 3-0 silk sutures and skin staples. RESULTS Twenty-two patients with gastric cancer under- went laparoscopic-assisted distal subtotal gastrec- tomy with lymph node dissection without naso- gastric decompression. Instead, a 9 cm long 19- gauge disposable needle was introduced percu- taneously during the operative period to decom- press the gastrointestinal tract. The patients' characteristics were comparable to usual gastric cancer patients. Patients were 15 males and 7 females with a mean age of 57 years (range 35-78 years). Among them, 11 patients had no other co-morbid diseases whereas the other 11 patients had one or more co-morbid disease such as hypertension, diabetes mellitus, or pulmonary diseases. The results were good with only one patient experiencing wound infection (4.5%) and one patient with postoperative acalculus cholecystitis (4.5%). There were no patients with either intraabdominal infection or anastomotic leakage. None of the 21 patients experienced vomiting in the postoperative period, however, the one patient (4.5%) who experienced acalculus cholecystitis complained of nausea and showed clinical and radiological abdominal distension. The restoration of bowel sounds was noted at 2.6 ± 0.7 postoperative days, first flatus was passed at 3.1 ± 0.6 postoperative days, soft diet was started at 4.6 ± 1.4 postoperative days and the duration of hospital stay was 7.5 ± 3.2 days. None of the patients needed postoperative nasogastric decompression, except the patient who experi- enced acaculus cholecystitis. Yonsei Med J Vol. 46, No. 5, 2005 DISCUSSION Percutaneous needle decompression technique during laparoscopic gastric surgery can be used without complications as an alternative to naso- gastric tube for intraoperative decompression of the gastrointestinal tract for an uncluttered sur- gical field. This technique can prevent possible injuries caused by the insertion of a nasogastric tube. We find it is an easy and simple technique to perform. Many surgeons have reported benefits from not using the nasogastric tube during and after major abdominal surgeries, including gastric surgery. 1-5,7,8 In spite of these reports, many surgeons still use nasogastric tubes during and after gastric cancer surgery for better surgical exposure and because of the belief that the gastrointestinal decompression might prevent serious complica- tions such as anastomotic leak, aspiration, and wound dehiscence, without any scientific evi- dences.7 The benefit of nasogastric decompression has been questioned in many clinical trials, that compared selective versus routine nasogastric decompression after abdominal surgery.1-3,9 It is well recognized that nasogastric tubes cause significant patient discomfort such as sore throat, ear pain, nasal soreness, and painful swallowing. Nasoga- stric decompression is associated with an in- creased incidence of complications e.g. fever, atelectasis, pneumonia and potential injuries to the nose, pharynx, esophagus, and stomach.7-10 Nasal, pharyngeal, esophageal, and gastric inju- ries can be caused by the intubation procedure itself not by the postoperative tube indwelling status.9,10 The intraoperative needle decompression tech- nique has been proposed to make it possible to perform gastrectomy with extended lymph node dissection without pre-, intra- and postoperative nasogastric decompression.5 Percutaneous needle decompression for laparoscopic gastric surgery is a modified technique of this intraoperative needle decompression technique. This procedure is very simple and efficient and has little risk of post- operative complications. This technique can be used as an alternative to nasogastric tube decom- pression of the gastrointestinal tract during laparoscopic gastric surgery.