Comparison of the short-term outcomes between delta-shaped anastomosis and conventional Billroth I anastomosis after laparoscopic distal gastrectomy

Abstract

Background:The conventional Billroth I anastomosis (cBIA) after laparoscopic distal gastrectomy (LDG) is performed through circular staple extracorporeally. Now, delta-shaped anastomosis (DA), which is performed using a linear stapler intracorporeally, becomes popular. We conducted a meta-analysis to compare the effectiveness and safety between the 2 techniques.Methods:A systematic literature search was performed using PubMed, Ovid, and the Cochrane Library Central. Participants of any age and sex, who underwent DA, or cBIA after LDG, were considered following inclusion criteria.Results:A total of 11 articles, published between 2010 and 2017, fulfilled the selection criteria. The total sample size of these studies was 2729 cases, including DA group 1008 cases and cBIA group 1721 cases. Compared to cBIA group, patients in DA group had less blood loss (mean deviation [MD] = −0.68, 95% confidence interval [CI] = −0.15 to −0.31, P < .001), fewer administration of analgesics (MD = −0.82, 95% CI = −1.58 to −0.05, P = .04), lower NRS score on POD 1 (MD = −0.84, 95% CI = −1.34 to −0.33, P = .001), lower NRS score on POD 3 (MD = −0.38, 95% CI = −0.50 to −0.26, P < .001). Furthermore, compared to cBIA group, obese patients in DA group had fewer total number of complications (MD = 0.46, 95% CI = 0.22 to 0.95, P = .04), shorter postoperative hospital stays (MD = −0.73, 95% CI = −1.18 to −0.28, P = .001), earlier first flatus (MD = −0.30, 95% CI = −0.50 to −0.10, P = .004), fewer administration of analgesics (MD = −1.08, 95% CI = −1.61 to −0.55, P < .001), lower NRS score on POD 1 (MD = −0.68, 95% CI = −0.99 to −0.37, P < .001) and lower NRS score on POD 3 (MD = −0.63, 95% CI = −0.86 to −0.40, P < .001).Conclusions:Compared with cBIA, DA is a safe and feasible procedure, with similar surgical outcomes and postoperative complications. In terms of postoperative recovery, DA is less invasive with quicker resume than cBIA, especially for the obese patients.

Short-Term Outcomes of Intracorporeal Delta-Shaped Gastroduodenostomy Versus Extracorporeal Gastroduodenostomy after Laparoscopic Distal Gastrectomy for Gastric Cancer

“…Many reports have evaluated the surgical outcomes and safety of ICBI versus ECBI [6781316171819202122]. A recent meta-analysis [910] of more than 10 articles revealed that ICBI was feasible and safe. Although many reports [56789101316171819202122] have shown that total laparoscopic ECBI anastomosis is feasible and safe, some surgeons still avoid the procedure and hesitate to perform ICBI anastomosis using linear staplers due to concerns about anastomosis problems.…”

“…A recent meta-analysis [910] of more than 10 articles revealed that ICBI was feasible and safe. Although many reports [56789101316171819202122] have shown that total laparoscopic ECBI anastomosis is feasible and safe, some surgeons still avoid the procedure and hesitate to perform ICBI anastomosis using linear staplers due to concerns about anastomosis problems. Considering that surgeons currently perform laparoscopic gastrectomy after adaptation for open gastrectomy, it is anticipated that surgeons would be comfortable performing ECBI anastomosis under direct vision using the circular stapler, similar to open surgery.…”

“…Several previous reports [3567891018] showed that obese patients have more complications with the mini-laparotomy wound in ECBI, where there is a narrow and restricted space for safe anastomosis. However, in this study, high BMI (≥30), but not the anastomotic method, was the risk factor for surgical complications.…”

“…With various instrument developments and techniques, gastroduodenostomy can be performed totally laparoscopically via intracorporeal anastomosis. Many studies have accumulated data comparing laparoscopically assisted distal gastrectomy (LADG), which has been performed with extracorporeal anastomosis since the first laparoscopic surgery, and total laparoscopic distal gastrectomy (TLDG), which has been performed with intracorporeal anastomosis regarding the safety of both procedures [5678910]. Although previous studies showed the advantages and disadvantages of laparoscopic distal gastrectomy with intracorporeal or extracorporeal anastomosis, some surgeons remain concerned that the previously reported data are insufficient to determine the safety of intracorporeal anastomosis.…”

Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer

“…Several studies have demonstrated that DA resulted in less blood loss and faster recovery than B-I, especially in obese patients. However, no difference was found in the surgical outcomes (operative time, number of harvested lymph nodes, and proximal margin) and postoperative complications (anastomotic leakage, stricture, hemorrhage, and wound complications) [22][23][24] (Table 1). However, some researchers have indicated that DA may affect the blood supply during cutting and result in an increased risk of anastomosis-related complications [25] .…”