Comparison of Delta-Shape Anastomosis and Extracorporeal Billroth I Anastomosis after Laparoscopic Distal Gastrectomy for Gastric Cancer: A Systematic Review with Meta-Analysis of Short-Term Outcomes

Abstract

ObjectiveThe aim of this systematic review and meta-analysis is to evaluate the safety and relative benefits of delta-shape anastomosis (DA) by comparing to conventional laparoscopy-assisted distal gastrectomy with Billroth I gastroduodenostomy (LADG BI).MethodsStudies and relevant literature regarding DA versus LADG BI were searched in the electronic databases. Operation time, postoperative complications, estimated blood loss, number of retrieved lymph nodes, time to first flatus, time to oral intake, length of postoperative hospitalization in DA and LADG BI were pooled and compared using meta-analysis. Weighted mean differences (WMDs) and odds ratios (ORs) were calculated with 95% confidence intervals (CIs) to evaluate the effect of DA.ResultsEight studies of 1739 patients were included in the meta-analysis. Compared with LADG BI, DA had shorter postoperative hospitalization (WMD = -0.47, 95%CI: -0.69 to -0.25, P<0.01), less blood loss (WMD = - 25.90, 95%CI: -43.11 to -8.70, P<0.01), shorter time to oral intake (WMD = -0.25, 95%CI: -0.49 to -0.01, P = 0.04), and more retrieved lymph nodes (WMD = 1.36, 95%CI: 0.30 to 2.43, P = 0.01). Operation time (WMD = -0.07, 95%CI -15.58 to 15.43, P = 0.99), overall postoperative complication rate (OR = 1.05, 95%CI: 0.74 to 1.49, P = 0.63), surgical complication rate (OR = 1.02, 95%CI: 0.70 to 1.49, P = 0.90), nonsurgical complication rate (OR = 1.21, 95%CI: 0.54 to 2.72, P = 0.64), leakage rate (OR = 2.54, 95%CI: 0.92 to 7.01, P = 0.07), stricture rate (OR = 0.36, 95%CI: 0.09 to 1.44, P = 0.15), wound complication rate (OR = 0.71, 95%CI: 0.33 to 1.55, P = 0.39), time to first flatus (WMD = -0.10, 95%CI: -0.27 to 0.07, P = 0.26), and proximal surgical margin (WMD = -0.25, 95%CI: -1.14 to 0.65, P = 0.59) was not statistically different.ConclusionCompared with LADG BI, DA is a safe and feasible procedure, with significantly reduced blood loss, time to oral intake, and postoperative hospitalization.

The safety and feasibility of intra‐corporeal gastroduodenostomy using a self‐pulling and latter transected method (Delta SPLT) in totally laparoscopic distal gastrectomy

“…Known as one of the classic intra-corporeal construction methods, DA is considered safe and has a short recovery period. [7][8][9] In experienced hands, the operation duration may be shorter than that for open or laparoscopy-assisted gastrectomy. [8][9][10][11][12] However, DA is not routinely practiced in China, since it requires advanced operative skills and has added instrument costs.…”

Uncut Roux-en-Y gastrojejunostomy after totally laparoscopic distal gastrectomy: Learning curve and surgical outcomes

“…Our results showed the safety and feasibility of uRYGJ, and that the technical difficulty of the procedure can be overcome with a relatively short learning curve for experienced surgeons. The learning curve was no longer than 10 to 29 cases for intracorporeal B-I anastomosis [25][26][27], which is ac- cepted as a technically less challenging procedure. There are several limitations to this study.…”

T-shaped Modified Delta Anastomosis as a Simple Intracorporeal Gastroduodenostomy

“…Lately, a DA is a widely accepted procedure for a TLDG. [11][12][13][14] Recent studies have shown that TLDG with DA offers several advantages over the LADG procedure. Kim et al have reported that because the stomach is not pulled through a minilaparotomy during a DA, injuries that can occur secondary to excessive tension during LADG can be avoided, and good visualization of the operative field can be obtained, making DA a favorable option for patients with obesity.…”

“…12 A recent meta-analysis that described TLDG and LADG has reported that TLDG with DA is safer and more feasible than LADG, and that it offers the advantage of significantly reduced blood loss, earlier resumption of oral intake, and a shorter postoperative hospitalization period. 13 However, cDA is associated with a few drawbacks. Kitakami et al have reported that duodenal ischemia can occur during the preparation process, which involves dissection of the tissues surrounding the posterior wall of the duodenum prior to stapling.…”

“…10 Since then, TLDG with DA has been widely used, and its safety and feasibility have been proven. [11][12][13][14][15][16] However, conventional delta anastomosis (cDA) is associated with certain drawbacks. A few authors have reported a risk of injury to the duodenal feeding vessels 17 and an anastomotic leak because of the presence of 2 weak points where the staple lines are observed to cross.…”