Augmented rectangle technique for Billroth I anastomosis in totally laparoscopic distal gastrectomy for gastric cancer
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Billroth I reconstruction is a means of anastomosis that is widely performed after surgical resection for distal gastric cancer. Interest has grown in totally laparoscopic gastrectomy, and several methods for totally laparoscopic performance of Billroth I reconstruction have been reported. However, the methods are cumbersome, and postoperative complications such as twisting at the site of anastomosis and obstruction due to stenosis have arisen. We developed an augmented rectangle technique (ART) by which the anastomosis is created laparoscopically with the use of three automatic endoscopic linear staplers, and the resulting anastomotic opening is wide and less likely to become twisted or stenosed. The technical details of our ART-based Billroth I anastomosis are presented herein along with results of the procedure to date.
The technique was applied in 160 patients who underwent totally laparoscopic distal gastrectomy for gastric cancer between December 2013 and August 2017. Clinicopathological data, surgical data, and postoperative outcomes were analyzed.
During surgery, there were no troubles associated with gastrointestinal reconstruction and there was no transition to laparotomy. There were no postoperative complications, including suture failure and stenosis, associated with the gastrointestinal reconstruction, and the average postoperative hospital stay was 12 days.
Totally laparoscopic ART-based Billroth I reconstruction is both feasible and safe. We expect this technique to contribute to the spread of safe totally laparoscopic surgery for gastric cancer.
KeywordsAugmented rectangle technique (ART) Billroth I anastomosis Totally laparoscopic distal gastrectomy Gastroduodenostomy
We acknowledge Duncan Mark Douglas, MD, from the Department of General Surgery, Johns Hopkins University, as the first to refer to our anastomosis technique as ART.
Compliance with ethical standards
Tetsu Fukunaga, Yuji Ishibashi, Shinichi Oka, Satoshi Kanda, Yukinori Yube, Yoshinori Kohira, Yuta Matsuo, Osamu Mori, Shinya Mikami, Takeharu Enomoto, and Takehito Otsubo have no conflict of interest or financial ties to disclose.
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