Safety and feasibility during the initial learning process of intracorporeal Billroth I (delta-shaped) anastomosis for laparoscopic distal gastrectomy
Intracorporeal Billroth I (ICBI) (delta-shaped) anastomosis is being increasingly used for laparoscopic distal gastrectomy. However, few studies have focused on the safety and feasibility of adopting this new technique. The present study aimed to review the surgical outcomes after the initial experience of performing ICBI anastomosis and to evaluate whether this technique can be safely adopted without increasing operative risk during the early learning process.
Forty-two consecutive patients who underwent ICBI anastomosis with laparoscopic distal gastrectomy by a single surgeon were enrolled, and their operative outcomes and hospital course were compared with those of 179 patients who underwent conventional extracorporeal Billroth I (ECBI) anastomosis by the same operator. The learning curve was assessed by evaluating the moving average of anastomosis time.
The operating time in the ICBI group was significantly longer than that in the ECBI group (142 vs. 116 min, p < 0.001). However, there were no significant differences in the postoperative hospital course such as gas passage, diet initiation, postoperative fever, and hospital stay between the two groups. Postoperative morbidity did not significantly differ between the ICBI and ECBI groups (7.1 vs. 12.3 %, p = 0.428). No anastomosis-related complications occurred in the ICBI group. The mean anastomosis time for ICBI anastomosis was 24 ± 5 min, and the anastomosis average time curve showed that it reached a plateau approximately after the 14th case.
ICBI anastomosis has a steep learning curve without increasing operative risk in the early learning process, when performed by experienced laparoscopic surgeons. The technical feasibility and clinical advantages of intracorporeal anastomosis need to be proven in future clinical trials.
KeywordsGastric carcinoma Intracorporeal anastomosis Laparoscopic gastrectomy Feasibility Learning curve Billroth I reconstruction
- 5.Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420CrossRefPubMedGoogle Scholar
- 12.Kim DG, Choi YY, An JY, Kwon IG, Cho I, Kim YM, Bae JM, Song MG, Noh SH (2013) Comparing the short-term outcomes of totally intracorporeal gastroduodenostomy with extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer: a single surgeon’s experience and a rapid systematic review with meta-analysis. Surg Endosc 27:3153–3161CrossRefPubMedGoogle Scholar
- 16.Sobin LH, Gospodarowicz MK, Wittekind Ch (eds) (2009) International union against cancer (UICC) TNM classification of malignant tumors. 7th edn. Wiley, OxfordGoogle Scholar
- 18.Kitano S, Yang HK (eds) (2012) Laparoscopic gastrectomy for cancer—standard techniques and clinical evidences (Chapter 20), 1st edn. Springer, TokyoGoogle Scholar
- 19.Kanaji S, Harada H, Nakayama S, Yasuda T, Oshikiri T, Kawasaki K, Yamamoto M, Imanishi T, Nakamura T, Suzuki S (2013) Surgical outcomes in the newly introduced phase of intracorporeal anastomosis following laparoscopic distal gastrectomy is safe and feasible compared with established procedures of extracorporeal anastomosis. Surg Endosc. doi:10.1007/s00464-013-3315-7
- 23.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 18:54–58CrossRefPubMedGoogle Scholar