Modified delta-shaped gastroduodenostomy consisting of linear stapling and single-layer suturing with the operator positioned between the patient’s legs: A technique preventing intraoperative duodenal injury and postoperative anastomotic stenosis

Tokuhara, Takaya; Nakata, Eiji; Tenjo, Toshiyuki; Kawai, Isao; Kondo, Keisaku; Hatabe, Shigeru

doi:10.1371/journal.pone.0230113

Cited by 3 publications

(7 citation statements)

References 23 publications

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“…The operative time of TLDG with intra-corporeal gastroduodenostomy completed with LS reported in literatures varied greatly from 127min to 291min, with the reconstruction duration from 12.2 min to 51.9 min(Table 1) [9][10][11][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]]. Omori et al [12] reported that the operative time of TLDG with intra-corporeal gastroduodenostomy completed with CS was 279 (range, 208-319) min.…”

Section: Discussionmentioning

confidence: 99%

“…The number of linear stapler cartridges used in the intra-corporeal gastroduodenostomy completed with LS reported in literatures varied from 2 to 5 [9][10][11][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]]. Omori et al [12] reported that 1 CS with 1 or 2 LS cartridges were used in the intra-corporeal gastroduodenostomy completed with CS.…”

Section: Discussionmentioning

confidence: 99%

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Intra-corporeal hand-sewn gastroduodenostomy in totally laparoscopic distal gastrectomy: Preliminary Experience with 21 Cases

Zhang

Cen

Huang

et al. 2022

Preprint

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Purpose Various procedures of intra-corporeal gastroduodenostomy in totally laparoscopic distal gastrectomy(TLDG) have been devised, but an optimal method has not yet been standardized. Studies of intra-corporeal hand-sewn gastroduodenostomy in TLDG are limited. In this study, we present our experience of intra-corporeal hand-sewn gastroduodenostomy in TLDG. Methods From December 2018 to October 2021, 21 patients underwent TLDG using intra-corporeal hand-sewn gastroduodenostomy for gastric cancer. The data of the patient demographics, intraoperative variables, postoperative hospital stay, morbidity, mortality, pathologic findings and follow-up were collected. Results All patients were successfully operated on without conversion to open- or laparoscope-assisted surgery. The median operative time was 175 min (range, 152-240min), with a reconstruction duration of 21 min (range, 15- 34min) .The time until first flatus was 4 days (range,2-6d). The time to starting a soft diet was 7 days (range,3-16d). There were no anastomotic complications. The morbidity rate was 4.76% with one case of delayed gastric emptying. There was no postoperative 30-day mortality and reoperation. The median postoperative hospital stay was 8 days(range,6-19d). Median follow-up time was 15 months (range,3-36m), no anastomotic strictures were encountered. Conclusions Intra-corporeal hand-sewn gastroduodenostomy in TLDG is a safe and feasible procedure. This method with lower surgical costs could be a good option for performing intracorporeal gastroduodenostomy with an advanced laparoscopic suture technique.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intra-corporeal hand-sewn gastroduodenostomy in totally laparoscopic distal gastrectomy: Preliminary Experience with 21 Cases

Zhang

Cen

Huang

et al. 2022

Preprint

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Section: Discussionmentioning

confidence: 99%

“…Although DS anastomosis has been widely accepted as a simple and easy procedure, the potential risk of postoperative anastomotic stenosis has been pointed out when the length of the duodenal bulb is short 10,11 . Some modified DS anastomosis have been reported to prevent anastomotic stenosis 11,12 . However, these procedures are functional end‐to‐end anastomosis and the SHS procedure is a true end‐to‐end anastomosis modified BBT, at least 30 mm length of staple is enough to fix the posterior wall of anastomosis and the anterior wall of anastomosis was performed by hand sewing.…”

Section: Discussionmentioning

confidence: 99%

Intracorporeal semi‐hand‐sewn Billroth I reconstruction in total laparoscopic distal gastrectomy

Kikuchi

Kuroda

Nishizaki

et al. 2020

Asian J Endoscop Surgery

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Introduction Intracorporeal Billroth I (B‐I) reconstruction using an endoscopic linear stapler (ELS) is widely performed in total laparoscopic distal gastrectomy. However, conventional procedures require many ELSs for anastomosis. Here, we introduce the novel intracorporeal semi‐hand‐sewn (SHS) B‐I reconstruction. Materials and surgical technique After the transection of stomach and duodenum using ELS following adequate lymph node dissection, small entry holes were made on the anterior wall in the greater curvature of the stomach and the duodenal stump. The posterior walls of both the remnant stomach and the duodenum were attached with the ELS and fired to create the posterior wall of the B‐I anastomosis. All the transection line of the duodenum and one‐third of the transection line of the stomach were dissected; finally the anterior wall suturing at the anastomotic site was performed by the laparoscopic hand‐sewn technique. Discussion SHS procedure was performed for 17 gastric cancer patients. There were no intraoperative complications or conversions to open surgery. One intra‐abdominal abscess was observed although there was no anastomotic leakage. The median reconstruction time was 48 minutes (32‐63). The SHS procedure was safe, feasible, and economical, although it requires sufficient laparoscopic suturing and ligation skill.

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“…In DSG, to obtain an adequate anastomotic area for the purpose of preventing anastomotic stenosis, the unsuccessful posteroanterior transection of the duodenal bulb due to its incomplete twisting may lead to extensive dissection of the supraduodenal vessels, that is, dissection of not only the cranial but also the caudal supraduodenal vessels ( 24 ). Similarly, when the duodenal bulb diameter is relatively short, extensive dissection of the supraduodenal vessels can be performed to obtain an adequate anastomotic area ( 26 ).…”

Section: Intracorporeal Linear-stapled Gastroduodenostomy With Preser...mentioning

confidence: 99%

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)

Tokuhara¹,

Nakata²,

Higashino³

2023

Oncol Lett

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The first part of the duodenum consists of the intraperitoneal segment, called the duodenal bulb, and the retroperitoneal segment. Regarding the blood supplying the duodenal bulb, which is the portion utilized in anastomosing the duodenum and remnant stomach following distal gastrectomy, the arterial pedicles branching off from the gastroduodenal artery are reported to reach the posterior wall first and then spread over the anterior wall, where they anastomose. When performing intracorporeal linear-stapled gastroduodenostomy following totally laparoscopic distal gastrectomy, the blood supply of the duodenal wall between the transecting staple line and anastomotic staple line needs to be considered because both transection of the duodenal bulb and the gastroduodenostomy are performed using an endoscopic linear stapler and the duodenal wall between the staple lines can be ischemic after the anastomosis. Since it needs to be decided intraoperatively whether this duodenal site is preserved or removed, the present review discusses the technical differences among several procedures for intracorporeal linear-stapled gastroduodenostomy, classifying them into two groups on the basis of the intraoperative management of this duodenal site. When this site is preserved, the blood supply of the duodenal wall needs to be retained with certainty. On the other hand, when this site is removed, the ischemic portion of the duodenal wall needs to be identified and removed. Furthermore, in both groups, an adequate anastomotic area needs to be secured. In conclusion, surgeons need to be familiar with the anatomical features of the duodenal bulb, including its blood perfusion and shape, when carrying out intracorporeal linear-stapled gastroduodenostomy.

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Modified delta-shaped gastroduodenostomy consisting of linear stapling and single-layer suturing with the operator positioned between the patient’s legs: A technique preventing intraoperative duodenal injury and postoperative anastomotic stenosis

Cited by 3 publications

References 23 publications

Intra-corporeal hand-sewn gastroduodenostomy in totally laparoscopic distal gastrectomy: Preliminary Experience with 21 Cases

Intra-corporeal hand-sewn gastroduodenostomy in totally laparoscopic distal gastrectomy: Preliminary Experience with 21 Cases

Intracorporeal semi‐hand‐sewn Billroth I reconstruction in total laparoscopic distal gastrectomy

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)

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