Modified Billroth-I Delta-Shaped Anastomosis After Distal Gastrectomy

Abstract

Laparoscopic distal gastrectomy is increasingly implemented worldwide according to the positive outcomes of some randomized studies. In terms of reconstruction, several methods have been attempted such as Billroth-I, Billroth II, or Roux-en-Y. Each method has pros and cons, and probably decisions are made according to the individual patient’s conditions, surgeon’s preference, or regional trends. Advantages of Billroth-I are simplicity, save of time, and physiologicalpassage of foods. In general, localized tumors at the antrum or lower stomachStomach body seem to be suitable candidates. As an intracorporeal Billroth-I reconstruction, delta-shapedDelta-shaped anastomosisAnastomosis only using a linear staplerLinear stapler is broadly accepted, which was originated from the concept of functional end-to-end anastomosis. Moreover, in our modified method, the duodenal stump is completely resected with a planned twice stapling when closing the entry hole, which may lead to no concern about ischemic area at the duodenum.