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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

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).

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Authors and Affiliations

  1. Department of Surgery, Ajou University School of Medicine, San5, Wonchon-Dong, Yeongtong-Gu, Suwon, 443-749, Korea

    Cheulsu Byun, Long Hai Cui, Sang-Yong Son, Hoon Hur, Young Kwan Cho & Sang-Uk Han

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  1. Cheulsu Byun
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  2. Long Hai Cui
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  3. Sang-Yong Son
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  4. Hoon Hur
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  5. Young Kwan Cho
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Correspondence to Sang-Uk Han.

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Disclosure

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.

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Byun, C., Cui, L.H., Son, SY. et al. Linear-shaped gastroduodenostomy (LSGD): safe and feasible technique of intracorporeal Billroth I anastomosis. Surg Endosc 30, 4505–4514 (2016). https://doi.org/10.1007/s00464-016-4783-3

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  • DOI: https://doi.org/10.1007/s00464-016-4783-3

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