Modified hemi-double-stapling technique combined with the temporal abdominal wall-lift method for performing Billroth I anastomosis after laparoscopically assisted distal gastrectomy

Abstract

The authors have used a modified hemi-double-stapling (HDS) technique for reconstruction after laparoscopically assisted distal gastrectomy. The stomach is resected from the greater curvature side using a linear stapler inserted into the stomach from that side at a position vertical to the line of the greater curvature. Resection of the stomach is performed by extending the resection line to the lesser curvature using laparoscopic coagulating shears. The resected specimen is examined. After placement of a purse-string suture at the duodenal stump, an anvil is inserted into the stump, and an additional suture with 2-0 silk is placed over the purse-string suture. A curved intraluminal stapler (CDH25) is inserted into the stomach through the opening made on the lesser curvature side, and the center rod of the stapler is passed through the gastric wall on the corner of the resection line at the greater curvature. Ligation with 2-0 silk is added to the center rod by suturing the gastric tissue 5-8 mm from the center rod to encircle it. The authors call this the "one-knot setup HDS," and with this method, a large-caliber anastomosis is secured. In many cases, it is difficult to observe the anastomotic site through the small incisional opening. However, under laparoscopy with the temporal abdominal wall-lift method using the Multi Flap Gate, the anastomotic site can be easily and safely observed. One-knot setup HDS combined with the temporal abdominal wall-lift method is considered a safe and simple method for performing Billroth I anastomosis in laparoscopic distal gastrectomy.

Feasibility of Delta-Shaped Anastomoses in Totally Laparoscopic Distal Gastrectomy

“…In addition, RY anastomosis is more appropriate for laparoscopic surgery than BI reconstruction [6,10,12,18,19]. The circular stapler is sometimes used for anastomosis via BI [20,21]. However, troublesome extracorporeal hand sewing has been used for laparoscopic BI reconstruction [22], and therefore the BI anastomosis has been believed to be a method that is not suited for totally laparoscopic surgery.…”

Two-Step Laparoscopic Surgery for a Patient with Synchronous Double Cancer of the Colon and Stomach Accompanied by Severe Chronic Obstructive Pulmonary Disease

“…D1 lymphadenectomy was performed by an usual method (Figure 2(b)), and transection of the duodenum and stomach was cut using an endoscopic liner stapler (GIA stapling system, blue; Covidien, Tokyo, Japan, Figure 2(c)). Billroth I reconstruction was performed by the hemi-double-stapling technique using circular stapler (DST Series EEA Stapler 28; Covidien Japan, Figure 2(d)) [10]. Removal of the resected stomach and anastomosis were performed through a 4 cm incision in the upper middle abdomen (Figure 1).…”