Application of Overlap Gastroduodenostomy in Billroth I Anastomosis after Totally Laparoscopic Distal Gastrectomy for Gastric Cancer

Abstract

Delta-shaped gastroduodenostomy (DSGD) and overlap gastroduodenostomy (OGD) are the two most widely used intracorporeal Billroth I anastomosis methods after distal gastrectomy. In this study, we compared the short-term outcomes of DSGD and OGD in total laparoscopic distal gastrectomy (TLDG). In a retrospective cohort study, we examined 92 gastric cancer patients who underwent TLDG performed by the same surgeon between January 2014 and June 2018. All patients underwent Billroth I reconstruction (OGD, n = 45; DSGD, n = 47) and D2 lymph node dissection. We retrospectively reviewed the surgical outcomes, clinical pathological results, and endoscopy results. Laparoscopic surgery was successfully performed in both groups without conversion to open surgery. The demographic and clinical characteristics were similar between the two groups ( P > 0.05 ). There were no significant differences between the two groups in operation time (158.9 ± 13.6 min vs. 158.8 ± 14.8 min, P = 0.955 ), anastomotic time (19.4 ± 3.0 min vs. 18.8 ± 2.9 min, P = 0.354 ), intraoperative blood loss (88.9 ± 25.4 mL vs. 83.7 ± 24.3 mL, P = 0.321 ), number of lymph node dissections (31.0 ± 7.1 vs. 29.2 ± 7.5, P = 0.229 ), length of hospital stay (8.8 ± 2.7 days vs. 9.1 ± 3.0 days, P = 0.636 ), fluid intake time (3.1 ± 0.7 days vs. 3.2 ± 0.7 days, P = 0.914 ), and morbidity of postoperative complications (6.7% [3/45] vs. 10.6% [5/47], P = 0.499 ). Endoscopy performed 6 months postoperatively showed that the residual food ( P = 0.033 ), gastritis ( P = 0.029 ), and bile ( P = 0.022 ) classification score significantly decreased in the OGD group, and there were no significant differences 12 months postoperatively. OGD is a safe and effective reconstruction technique with comparable postoperative surgical outcomes and endoscopy results when compared with those of DSGD.

Intracorporeal linear‑stapled gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: Consideration of the intraoperative management of the duodenal wall between the transecting staple line and anastomotic staple line (Review)

“…Some authors have expressed concern that an insufficient supply of blood to the duodenal wall between the transecting staple line and anastomotic staple line in DSG could be caused by unsuccessful transection of the duodenal bulb in a posteroanterior direction and the extensive dissection of supraduodenal vessels ( 11 , 17 , 21 – 25 ). Iwasaki et al ( 24 ) indicated that the twisting of the duodenal bulb at the posteroanterior transection is technically demanding.…”

“…We hypothesized that although the blood supply via the remnant cranial supraduodenal vessels is blocked by the anastomotic linear staple, the blood supply of this area in the DSG is assumed to be retained via the caudal supraduodenal vessels because the caudal and cranial supraduodenal vessels anastomosed at the anterior wall, that is, at the antimesenteric side (4,5). Some authors have expressed concern that an insufficient supply of blood to the duodenal wall between the transecting staple line and anastomotic staple line in DSG could be caused by unsuccessful transection of the duodenal bulb in a posteroanterior direction and the extensive dissection of supraduodenal vessels (11,17,(21)(22)(23)(24)(25). Iwasaki et al (24) indicated that the twisting of the duodenal bulb at the posteroanterior transection is technically demanding.…”

“…Several studies have reported OG in B-I reconstruction following TLDG (25,(27)(28)(29)(30)(31). The duodenal bulb was transected from the greater curvature side to the lesser curvature side (25,27,(29)(30)(31), or from the posterior side to the anterior side (28).…”

“…Several studies have reported OG in B-I reconstruction following TLDG (25,(27)(28)(29)(30)(31). The duodenal bulb was transected from the greater curvature side to the lesser curvature side (25,27,(29)(30)(31), or from the posterior side to the anterior side (28). Before the gastroduodenostomy, no dissection of the supraduodenal vessels aimed at creating the space required for insertion of the ELS fork around the duodenum was performed (25,(27)(28)(29)(30)(31).…”

“…The duodenal bulb was transected from the greater curvature side to the lesser curvature side (25,27,(29)(30)(31), or from the posterior side to the anterior side (28). Before the gastroduodenostomy, no dissection of the supraduodenal vessels aimed at creating the space required for insertion of the ELS fork around the duodenum was performed (25,(27)(28)(29)(30)(31). The anterosuperior side or anterior wall of the first part of the duodenum and the greater curvature side or posterior wall of the remnant stomach were anastomosed by one linear staple so that the anastomotic staple line was perpendicular to the transecting staple line in the duodenum (25,(27)(28)(29)(30)(31).…”