Delta-Shaped Anastomosis in Totally Laparoscopic Billroth I Gastrectomy: New Technique of Intraabdominal Gastroduodenostomy1

Kanaya, Shigehiko; Gomi, Takashi; Momoi, Hirohito; Tamaki, Nobuharu; Isobe, Hisashi; Katayama, Tetsuo; Wada, Yasuo; Ohtoshi, Masahiro

doi:10.1016/s1072-7515(02)01239-5

Cited by 280 publications

(239 citation statements)

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“…The extended umbilical incision normally shrinks well within a few months. Following the gastric resection, the delta-shaped anastomosis was completed as described previously [1]. Our first choice of reconstructive procedure is the Billroth-I with the delta-shaped anastomosis.…”

Section: Delta-shaped Anastomosismentioning

confidence: 99%

“…The establishment of a novel, secure, intracorporeal anastomosis, therefore, is one priority in gastric surgery. We have developed a new, simple, and secure method of intracorporeal gastroduodenostomy, using only endoscopic linear staplers, which we have named the deltashaped anastomosis [1]. Because of its advantages, this procedure is gaining widespread acceptance among surgeons in Japan and Korea, where it is becoming a standard reconstruction procedure after laparoscopic distal gastrectomy [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

et al. 2011

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Background We developed a new method of intracorporeal gastroduodenostomy, the delta-shaped anastomosis, in which only endoscopic linear staplers are used. In this report, we present the short-and long-term outcomes of our initial experience with this procedure. Methods We retrospectively analyzed 100 consecutive gastric cancer patients who underwent the delta-shaped anastomosis procedure from May 2001 to November 2006. All of them underwent a laparoscopic distal gastrectomy with regional lymph node dissection. Quality of life was assessed with a questionnaire 6 months or more postoperatively, and the gastric remnant was evaluated by endoscopy one year following the surgery. Results Eight surgeons successfully performed the deltashaped anastomosis without any conversion to laparotomy. The learning curve for all surgeons was steep and the mean time for the anastomosis was 13 min. Only one patient developed an anastomotic leak, and the leak was minor. Sixty-five patients tolerated a 1500 kcal/day soft diet at the time of discharge. The mean follow-up period was 54.9 months. Only one patient reported symptoms indicative of dumping. Two patients were diagnosed with reflux esophagitis, and approximately 70% had evidence of bile reflux, but severe gastritis of the remnant stomach on endoscopy was uncommon. Conclusions The wide lumen of the delta-shaped anastomosis led to early, adequate postoperative oral intake without a significant incidence of dumping syndrome. The delta-shaped anastomosis is safe and simple and provides satisfactory postoperative results.

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Section: Delta-shaped Anastomosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

et al. 2011

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“…Totally laparoscopic gastrectomy (TLG) is one example. TLG has gained popularity since Kanaya et al [27] reported the first delta-shaped anastomosis. A recent meta-analysis (five studies, 652 patients) showed that totally laparoscopic distal gastrectomy has less bleeding, shorter time to first flatus, and lower rates of postoperative complications than LADG.…”

Section: Gastrectomymentioning

confidence: 99%

Minimally Invasive Surgery of Gastric Cancer

Güner

Hyung

2017

Minimally Invasive Surgery for Upper Abdominal Cancer

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Minimally invasive surgery for gastric cancer has rapidly gained popularity due to the early detection of early gastric cancer. As advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Recent evidence suggests that the short-and long-term outcomes of minimally invasive surgery for early gastric cancer and advanced gastric cancer are comparable to those of conventional open surgery. However, these results should be confirmed by large-scale multicenter prospective randomized controlled clinical trials.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Gastric cancer; Minimally invasive surgery; Laparoscopic gastrectomyCore tip: Minimally invasive surgery has become an alternative modality for the treatment of gastric cancer.Son SY, Kim HH. Minimally invasive surgery in gastric cancer. World J Gastroenterol 2014; 20(39): 14132-14141 Available from: URL: http://www.wjgnet.com/1007-9327/full/ v20/i39/14132.htm DOI: http://dx.doi.org/10.3748/wjg.v20. tano et al [9] and Nagai et al [10] reported the success of laparoscopy-assisted distal gastrectomy (LADG) for EGC in 1994 and 1995. In the early 2000s, robot-assisted surgery emerged as one of the treatment modalities for EGC, and the first robot-assisted gastrectomy (RAG) for EGC was reported by Hashizume et al [11] in 2003. In 2011, singleincision laparoscopic surgery was described for EGC [12] . MIS has revolutionized the surgical approach to gastric cancer for the past two decades, leading to improvements in patients' quality of life by producing less pain, less blood loss, earlier postoperative recovery, and a shorter hospital stay [13][14][15][16][17][18][19] .Currently, MIS is evolving in two major directions [20] . First, MIS techniques are being used in more radical but less invasive procedures, such as totally laparoscopic distal gastrectomy or laparoscopic total gastrectomy with D1+ or D2 lymphadenectomy. These procedures are comparable to conventional open surgery and can be performed even in patients with advanced gastric cancer (AGC) [21][22][23] . Second, MIS is being employed for function-preserving surgery, including pylorus-preserving gastrectomy (PPG), proximal gastrectomy, and limited gastrectomy with sentinel node navigation surgery. These procedures can assist in improving patients' late postoperative function and quality of life [20,[24][25][26] . RECENT ADVANCES IN LAPAROSCOPIC GASTRECTOMYAs advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Totally laparoscopic gastrectomy (TLG) is one example. TLG has gained popularity since Kanaya et al [27] reported the first delta-shaped anastomosis. A recent meta-analysis (five studies, 652 patients) showed that totally laparoscopic distal gastrectomy has less bleeding, shorter time to first flatus, and lower rates of postoperative complicat...

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“…Several surgeons have also reported the safety and feasibility of the totally laparoscopic gastrectomy [13][14][15]. Compared with the laparoscopy-assisted procedure, the totally laparoscopic gastrectomy was found to be less invasive because it does not require a mini-laparotomy.…”

Section: Introductionmentioning

confidence: 99%

“…Kanaya et al [13] described a new, simple, easy, and safe technique for creating an intracorporeal delta-shaped gastroduodenostomy in laparoscopic distal gastrectomy. Similarly, Lee et al [17] formed an intracorporeal deltashaped gastrogastrostomy during a laparoscopic segmental gastrectomy or PPG.…”

Section: Introductionmentioning

confidence: 99%

Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes

et al. 2014

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Introduction The feasibility, safety, and improved quality of postoperative life following laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with a hand-sewn anastomosis via a mini-laparotomy for early gastric cancer (EGC) have been previously established. Here we describe the surgical procedure of totally laparoscopic pylorus-preserving gastrectomy (TLPPG) using an intracorporeal delta-shaped anastomosis technique, and the short-term surgical outcomes of 60 patients with EGC in the middle stomach are reported. Methods After lymphadenectomy and mobilization of the stomach, intraoperative gastroscopy was performed in order to verify the location of the tumor, and then the distal and proximal transecting lines were established, 5 cm from the pyloric ring and just proximal to Demel's line, respectively. Following transection of the stomach, a deltashaped intracorporeal gastrogastrostomy was made with linear staplers. Results There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 259 min and 28 mL, respectively. Twelve patients (20.0 %) experienced postoperative complications classified as grade II using the Clavien-Dindo classification, with the most frequent complication being gastric stasis (6 cases, 10.0 %). The incidence of severe complications classified as grade III or above was 1.7 %; only one patient required reoperation and intensive care due to postoperative intraabdominal bleeding and subsequent multiple organ failure. Conclusion TLPPG with an intracorporeal delta-shaped anastomosis was found to be a safe procedure, although it tended to require a longer operating time than the wellestablished LAPPG with a hand-sewn gastrogastrostomy.

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Delta-Shaped Anastomosis in Totally Laparoscopic Billroth I Gastrectomy: New Technique of Intraabdominal Gastroduodenostomy1

Cited by 280 publications

References 9 publications

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

Minimally Invasive Surgery of Gastric Cancer

Totally laparoscopic pylorus-preserving gastrectomy for early gastric cancer in the middle stomach: technical report and surgical outcomes

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