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A new intracorporeal Billroth II stapled anastomosis technique in totally laparoscopic distal gastrectomy

Abstract

Background

We introduced a new, safe and simple intracorporeal Billroth II (B-II) gastrojejunostomy technique using laparoscopic linear staplers with totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. We further compared the short-term operative outcomes between intracorporeal B-II gastrojejunostomy with TLDG and extracorporeal B-II gastrojejunostomy with laparoscopy-assisted distal gastrectomy (LADG).

Methods

From January 01, 2012 to January 31, 2013, a total of 36 patients with gastric cancer underwent TLDG and LADG. Overall, 11 patients underwent intracorporeal B-II gastrojejunostomy with TLDG, and 25 patients underwent a mini-laparotomy incision for extracorporeal B-II anastomosis with LADG. Perioperative parameters, including patient and tumor characteristics, short-term postoperative outcomes, and anastomosis-related complications, were analyzed to compare the two operations.

Results

The time to first flatus, the time on a liquid diet, and the mean postoperative length of hospital stay were significantly different between the groups (P < 0.05). In the TLDG group, the postoperative time to first flatus and the mean postoperative length of hospital stay were significantly shorter than in the LADG group (2.6 ± 0.20 vs. 3.8 ± 0.1 days; 10 ± 1.84 vs. 12.7 ± 3.35 days). However, the operation-related costs were significantly greater for totally laparoscopic distal gastrectomy (P < 0.001). The mean number of staples used in TLDG was six compared with four in LADG.

Conclusion

Our new intracorporeal B-II anastomosis method using laparoscopic linear staplers with TLDG was safe, feasible, and minimally invasive compared with extracorporeal B-II gastrojejunostomy with LADG. At the same time, one of its characteristics of our technique is to avoid stricturing of the efferent loop or afferent loop of the jejunum when the entry hole is closed with a stapler.

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Disclosures

Chaojun Zhang, Weidong Xiao, Kang Chen, Zhicao Zhang, Guangsheng Du, Enlai Jiang, and Hua Yang have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Chaojun Zhang or Hua Yang.

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Zhang, C., Xiao, W., Chen, K. et al. A new intracorporeal Billroth II stapled anastomosis technique in totally laparoscopic distal gastrectomy. Surg Endosc 29, 1636–1642 (2015). https://doi.org/10.1007/s00464-014-3825-y

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Keywords

  • Laparoscopic surgery
  • Linear stapler
  • Gastrectomy
  • Billroth II anastomosis