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Augmented rectangle technique for Billroth I anastomosis in totally laparoscopic distal gastrectomy for gastric cancer

  • 2018 SAGES Oral
  • Published:
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan

    Tetsu Fukunaga, Yuji Ishibashi, Shinichi Oka, Satoshi Kanda, Yukinori Yube, Yoshinori Kohira, Yuta Matsuo & Osamu Mori

  2. Department of Gastroenterological and General Surgery, St. Marianna University, School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan

    Shinya Mikami, Takeharu Enomoto & Takehito Otsubo

Authors
  1. Tetsu Fukunaga
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  2. Yuji Ishibashi
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  3. Shinichi Oka
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  4. Satoshi Kanda
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  5. Yukinori Yube
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  6. Yoshinori Kohira
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  7. Yuta Matsuo
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  8. Osamu Mori
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  9. Shinya Mikami
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  10. Takeharu Enomoto
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  11. Takehito Otsubo
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Corresponding author

Correspondence to Tetsu Fukunaga.

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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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Fukunaga, T., Ishibashi, Y., Oka, S. et al. Augmented rectangle technique for Billroth I anastomosis in totally laparoscopic distal gastrectomy for gastric cancer. Surg Endosc 32, 4011–4016 (2018). https://doi.org/10.1007/s00464-018-6266-1

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  • DOI: https://doi.org/10.1007/s00464-018-6266-1

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