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).
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.
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.
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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Parkin DM (2001) Global cancer statistics in the year 2000. Lancet Oncol 2:533–543
Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics 2002. CA Cancer J Clin 55:74–108
Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C (2007) Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg 194(6):839–844
Mayers TM, Orebaugh MG (1998) Totally laparoscopic Billroth I gastrectomy. J Am Coll Surg 186:100–103
Chen Ke, Xiao-Wu Xu, Zhang RC, Pan Y, Wu D, Mou YP (2013) Systematic review and meta-analysis of laparoscopy-assisted and open total gastrectomy for gastric cancer. World J Gastroenterol 19(32):5365–5376
Shen Hongliang, Shan Chengxiang, Liu Sheng, Qiu Ming (2013) Laparoscopy-assisted versus open total gastrectomy for gastric cancer: a meta-analysis. J Laparoendosc Adv Surg Tech A 23(10):832–840
Lee Sang-Woong, Tanigawa Nobuhiko, Nomura Eiji, Tokuhara Takaya, Kawai Masaru, Yokoyama Kazutake, Hiramatsu Masako, Okuda Junji, Uchiyama Kazuhisa (2012) Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy. World J Surg Oncol 10:2678
Ikeda O, Sakaguchi Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, Ohga T, Adachi E, Toh Y, Okamura T, Baba H (2009) Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc 23(10):2374–2379
Kim BS, Yook JH, Choi YB, Kim KC, Kim MG, Kim TH, Kawada H, Kim BS (2011) Comparison of early outcomes of intracorporeal and extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A21:387–391
Lee SW, Tanigawa N, Nomura E, Tokuhara T, Kawai M, Yokoyama K, Hiramatsu M, Okuda J, Uchiyama K (2012) Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy. World J Surg Oncol 12(10):267
Goh P, Tekant Y, Kum CK, Isaac J, Shang NS (1992) Totally intra-abdominal laparoscopic Billroth II gastrectomy. Surg Endosc 6:160
Lee Junhyun, Kim Dongjin, Kim Wook (2012) Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer. J Korean Surg Soc 82(3):135–142
UICC International Union Against Cancer (1997) TNM classification of malignant tumors, 5th edn. Wiley, New York
Tanimura S, Higashino M, Fukunaga Y, Takemura M, Nishikawa T, Tanaka Y, Fujiwara Y, Osugi H (2008) Intracorporeal Billroth 1 reconstruction by triangulating stapling technique after laparoscopic distal gastrectomy for gastric cancer. Surg Laparosc Endosc Percutan Tech 18:54–58
Song KY, Park CH, Kang HC, Kim JJ, Park SM, Jun KH, Chin HM, Hur H (2008) Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study. J Gastrointest Surg 12:1015–1021
Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195:284–287
Lee HW, Kim HI, An JY, Cheong JH, Lee KY, Hyung WJ, Noh SH (2011) Intracorporeal anastomosis using linear stapler in laparoscopic distal gastrectomy: comparison between gastroduodenostomy and gastrojejunostomy. J Gastric Cancer 11(4):212–218
Kang KC, Cho GS, Han SU, Kim W, Kim HH, Kim MC, Hyung WJ, Ryu SY, Ryu SW, Lee HJ, Song KY, Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group (2011) Comparison of Billroth I and Billroth II reconstructions after laparoscopy-assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from Korea. Surg Endosc 25:1953–1961
Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara KA (2008) comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg 247:962–967
Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH (2005) The early experience with a totally laparoscopic distal gastrectomy. J Korean Gastric Cancer Assoc 5:16–22
Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, Park SM (2008) Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 22:436–442
Kanaya S, Kawamura Y, Kawada H, Iwasaki H, Gomi T, Satoh S, Uyama I (2011) The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer 14:365–371
Maehara Y, Kakeji Y, Oda S, Takahashi I, Akazawa K, Sugimachi K (2000) Time trends of surgical treatment and the prognosis for Japanese patients with gastric cancer. Br J Cancer 83:986–991
The Japanese Gastric Cancer Association (2001) Guidelines for the treatment of gastric cancer. Kanehara-Shuppan, Tokyo
Hosogi Hisahiro, Kanaya Seiichiro (2012) Intracorporeal anastomosis in laparoscopic gastric cancer surgery. J Gastric Cancer 12(3):133–139
Noshiro H, Ohuchida K, Kawamoto M, Ishikawa M, Uchiyama A, Shimizu S, Tanaka M (2009) Intraabdominal Roux-en-Y reconstruction with a novel stapling technique after laparoscopic distal gastrectomy. Gastric Cancer 12:164–169
Takaori K, Nomura E, Mabuchi H, Lee SW, Agui T, Miyamoto Y (2005) A secure technique of intracorporeal Roux-Y reconstruction after laparoscopic distal gastrectomy. Am J Surg 189:178–183
Du J, Shuang J, Li J, Zhao Q, Hong L, Du X, Wen J, Hua J (2012) Totally laparoscopic Billroth II gastrectomy with a novel, safe, simple, and time-saving anastomosis by only stapling devices. J Gastrointest Surg 16:738–743
Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y (2013) advantage of completely laparoscopic gastrectomy with linear stapled reconstruction a long-term follow-up study. Ann Surg 00:1–8
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.
About this article
Cite this article
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
- Laparoscopic surgery
- Linear stapler
- Billroth II anastomosis