A novel method of self-pulling and latter transected delta-shaped Billroth-I anastomosis in totally laparoscopic distal gastrectomy

Abstract

Background We developed a modified delta-shaped gastroduodenostomy technique in totally laparoscopic distal gastrectomy. This novel technique, which effectively reduces the required quantity of linear stapler [1][2][3], was named as self-pulling and latter transected delta-shaped anastomosis (Delta SPLT) [4]. Methods Delta SPLT was performed on 15 patients with stage cT1-2 antral cancer. We ligated the duodenum with a rope instead of transecting it and used the ligature rope to pull the duodenum during the whole progress of gastroduodenostomy. When closing the entry hole, the duodenum was transected at the same time, which saved one linear stapler. Data of clinicopathologic characteristics, surgical and postoperative outcomes were collected and expressed as means ± standard deviations. Results All the operations were successfully performed by using no more than four 60-mm linear staplers. The mean BMI of the patients is 23.0 ± 2.5 kg/m 2 (range 17.0-26.0 kg/m 2 ), and duration of the operation was 115.0 ± 33.4 min (range 75-215 min), including 22.3 ± 6.7 min (range 15-35 min) of reconstruction. Mean blood loss was 82.7 ± 71.3 mL (range 10-300 mL), and mean times to first flatus was 2.3 ± 1.1 days (range 1-5 days). A mean number of 27.5 ± 5.4 (range 18-38) lymph nodes was retrieved.Overall postoperative morbidity rate was 6.7% (1/15). There was no anastomosis-related complication, but one case of pneumonia developed on postoperative day (POD) 2 which was successfully managed by conservative methods. Patients were discharged (POD mean 5.8 ± 1.3, range 4-9) when their bowel movements recovered and no discomfort with soft diet was claimed. Conclusion Delta SPLT is a safe and feasible technique and requires less clinical costs.Keywords Totally laparoscopic distal gastrectomy Á Selfpulling Á Latter transection Á Delta-shaped anastomosis Á Gastroduodenostomy novel method of self-pulling and latter transected reconstruction in totally laparoscopic total gastrectomy: feasibility and short-term safety. Surg Endosc.

Application of Self-Pulling and Latter Transection in Totally Laparoscopic Total Gastrectomy

“…This study examined the e cacy and safety of SPLT-TLTG surgery compared to conventional LATG surgery. Consistent with other studies [4][5]9] , our study suggested that SPLT-TLTG surgery has the advantages of minimally invasive, reduced bleeding and rapid postoperative recovery. Meanwhile, avoid squeezing tumor tissue during the operation, which diminishes the risk of rupture and dissemination of the tumor during the operation [9] .…”

“…However, the technique di culties, especially during anastomose, impedes the wide use of this advanced surgery. A Chinese surgical team introduced a new anastomosis method, selfpulling and latter transection (SPLT) esophagojejunostomy after traction based on the overlap and functional end-to-end anastomosis (FETE) in TLTG [4] [5] . Their study indicated that SPLT is a simple and secure process that helped to apply TLTG surgery on patients with more advanced stages.…”

“…Their study indicated that SPLT is a simple and secure process that helped to apply TLTG surgery on patients with more advanced stages. Moreover, less than ve endoscopic linear staplers is required for lesion closure in this procedure, demanding much less in both clinical costs and surgical skills [5] . However, no comparison between SPLT-TLTG and LATG surgeries have been conducted to the best of our knowledge.…”

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

“…To reduce the technical difficulty and quantity of anastomotic instruments used, a modified DA technique named the "self-pulling and latter transected delta-shaped gastroduodenostomy" (Delta SPLT) was developed in 2016. 6 It requires only one stapler and four 60-mm cartridges, and it does not require any suturing by hand. This study was conducted to evaluate the postoperative safety and feasibility of the Delta SPLT technique by analyzing the surgical outcomes in the first year after the surgery.…”

“…In general, DA requires high‐level coordination between the operator and assistant, at least one endoscopic linear stapler, and five cartridges. To reduce the technical difficulty and quantity of anastomotic instruments used, a modified DA technique named the “self‐pulling and latter transected delta‐shaped gastroduodenostomy” (Delta SPLT) was developed in 2016 6 . It requires only one stapler and four 60‐mm cartridges, and it does not require any suturing by hand.…”