Surgical Endoscopy

, Volume 30, Issue 10, pp 4505–4514 | Cite as

Linear-shaped gastroduodenostomy (LSGD): safe and feasible technique of intracorporeal Billroth I anastomosis

  • Cheulsu Byun
  • Long Hai Cui
  • Sang-Yong Son
  • Hoon Hur
  • Young Kwan Cho
  • Sang-Uk HanEmail author



Although delta-shaped gastroduodenostomy (DSGD) is used increasingly as an intracorporeal Billroth I anastomosis after distal gastrectomy, worries about anatomical distortion always exist in twisting stomach and making an oblique incision on duodenum. We developed a new method of intracorporeal gastroduodenostomy, the linear-shaped gastroduodenostomy (LSGD), in which anastomosis is done using endoscopic linear staplers only without any complicated rotation. In this report, we introduced LSGD and compared its short-term and long-term outcomes with DSGD.


We analyzed 261 consecutive gastric cancer patients who underwent the intracorporeal gastroduodenostomy between January 2009 and May 2014 (LSGD: 190, DSGD: 71), retrospectively. All of them underwent a laparoscopic or robotic distal gastrectomy with regional lymph node dissection. Early surgical outcomes such as operation time, postoperative complications, days until soft diet began, length of hospital stay, and endoscopic findings in postoperative 6 and 12 months were evaluated.


Although the proportion of robotic approach and D2 lymphadenectomy were significantly higher in LSGD group, the rates for overall complications (13.2 % [LSGD] vs. 9.9 % [DSGD], p = 0.470) and major complications (5.8 vs. 5.6 %, p = 1.0) were similar between two groups. There were no differences in anastomotic bleeding (1.1 vs. 1.4 %, p = 1.0), stenosis (3.2 vs. 2.8 %, p = 1.0), and leakage (0.5 vs. 0.0 %, p = 1.0). Endoscopy performed 6 months postoperatively showed that residual food (p = 0.022), gastritis (p = 0.018), and bile reflux (42.0 vs. 63.2 %, p = 0.003) were significantly decreased in LSGD and there were no significant differences in postoperative 12 months.


LSGD is an innovative reconstruction technique with comparable short-term outcomes to DSGD. In addition, reduced residual food, gastritis, and bile reflux were seen in LSGD.


Gastric cancer Minimally invasive surgery Intracorporeal reconstruction Intracorporeal gastroduodenostomy Linear-shaped gastroduodenostomy Delta-shaped gastroduodenostomy 



This study was supported by a Grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1320270).

Compliance with ethical standards


Cheulsu Byun, Long Hai Cui, Sang-Yong Son, Hoon Hur, Young Kwan Cho, and Sang-Uk Han have no conflicts of interest or financial ties to disclose.


  1. 1.
    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMedGoogle Scholar
  2. 2.
    Jeong O, Park YK (2011) Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients. J Gastric Cancer 11:69–77CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kitano S, Shiraishi N (2004) Current status of laparoscopic gastrectomy for cancer in Japan. Surg Endosc 18:182–185CrossRefPubMedGoogle Scholar
  4. 4.
    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
  5. 5.
    Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727CrossRefPubMedGoogle Scholar
  6. 6.
    Hosogi H, Kanaya S (2012) Intracorporeal anastomosis in laparoscopic gastric cancer surgery. J Gastric Cancer 12:133–139CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    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
  8. 8.
    Omori T, Tanaka K, Tori M, Ueshima S, Akamatsu H, Nishida T (2012) Intracorporeal circular-stapled Billroth I anastomosis in single-incision laparoscopic distal gastrectomy. Surg Endosc 26:1490–1494CrossRefPubMedGoogle Scholar
  9. 9.
    Kim HI, Woo Y, Hyung WJ (2012) Laparoscopic distal gastrectomy with an intracorporeal gastroduodenostomy using a circular stapler. J Am Coll Surg 214:e7–13CrossRefPubMedGoogle Scholar
  10. 10.
    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 195:284–287CrossRefPubMedGoogle Scholar
  11. 11.
    Kim MG, Kawada H, Kim BS, Kim TH, Kim KC, Yook JH, Kim BS (2011) A totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG) for improvement of the early surgical outcomes in high BMI patients. Surg Endosc 25:1076–1082CrossRefPubMedGoogle Scholar
  12. 12.
    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 10:267CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y (2014) Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg 259:109–116CrossRefPubMedGoogle Scholar
  14. 14.
    Noshiro H, Iwasaki H, Miyasaka Y, Kobayashi K, Masatsugu T, Akashi M, Ikeda O (2011) An additional suture secures against pitfalls in delta-shaped gastroduodenostomy after laparoscopic distal gastrectomy. Gastric Cancer 14:385–389CrossRefPubMedGoogle Scholar
  15. 15.
    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 14:365–371CrossRefPubMedGoogle Scholar
  16. 16.
    Song HM, Lee SL, Hur H, Cho YK, Han S-U (2010) Linear-Shaped Gastroduodenostomy in Totally Laparoscopic Distal Gastrectomy. J Gastric Cancer 10:69–74CrossRefGoogle Scholar
  17. 17.
    Huang CM, Lin M, Lin JX, Zheng CH, Li P, Xie JW, Wang JB, Lu J (2014) Comparision of modified and conventional delta-shaped gastroduodenostomy in totally laparoscopic surgery. World J Gastroenterol 20:10478–10485CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Japanese Gastric Cancer, Association (2011) Japanese classification of gastric carcinoma: 3rd edn. Gastric Cancer vol 14, pp 101–112Google Scholar
  19. 19.
    Kim HI, Hyung WJ, Lee CR, Lim JS, An JY, Cheong JH, Choi SH, Noh SH (2011) Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy. Surg Endosc 25:958–963CrossRefPubMedGoogle Scholar
  20. 20.
    Xuan Y, Hur H, Byun CS, Han SU, Cho YK (2013) Efficacy of intraoperative gastroscopy for tumor localization in totally laparoscopic distal gastrectomy for cancer in the middle third of the stomach. Surg Endosc 27:4364–4370CrossRefPubMedGoogle Scholar
  21. 21.
    Japanese Gastric Cancer, Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer vol 14, pp 113–123Google Scholar
  22. 22.
    Huang C, Lin M, Chen Q, Lin J, Zheng C, Li P, Xie J, Wang J, Lu J (2014) A modified delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: a safe and feasible technique. PLoS ONE 9:e102736CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D, Sano T, Katai H (2002) Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer 5:83–89CrossRefPubMedGoogle Scholar
  24. 24.
    Lee HH, Song KY, Lee JS, Park SM, Kim JJ (2014) Delta-shaped anastomosis, a good substitute for conventional Billroth I technique with comparable long-term functional outcome in totally laparoscopic distal gastrectomy. Surgical Endosc 29:2545–2552CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Cheulsu Byun
    • 1
  • Long Hai Cui
    • 1
  • Sang-Yong Son
    • 1
  • Hoon Hur
    • 1
  • Young Kwan Cho
    • 1
  • Sang-Uk Han
    • 1
    Email author
  1. 1.Department of SurgeryAjou University School of MedicineSuwonKorea

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