Delta-shaped gastroduodenostomy after totally laparoscopic distal gastrectomy for gastric cancer: comparative study of original and modified methods

Abstract

Delta-shaped anastomosis (DA) has been widely accepted as a standard procedure for intracorporeal Billroth-I reconstruction after laparoscopic distal gastrectomy. We introduced DA in 2010 at our hospital and later developed a modified DA method in which a stapled corner of the duodenal stump was removed simultaneously with closure of an entry hole to reduce postoperative complications. The clinical data of 507 patients undergoing laparoscopic distal gastrectomy with DA from October 2010 through December 2018 were retrospectively collected from our in-house database. On the basis of the reviewed data, patients were divided into two groups: the original DA group (org-DA, n = 392) and the modified DA group (mod-DA, n = 115). Surgical outcomes, postoperative nutritional parameters, and endoscopic findings 1year after surgery were compared between the two groups. Baseline characteristics were similar between the two groups. Anastomotic stricture occurred in three patients (0.8%) in the org-DA group and one patient (0.9%) in the mod-DA group (P = 0.911). Anastomotic leakage was recorded in five patients (1.3%) in the org-DA group and none of the patients (0%) in the mod-DA group (P = 0.593). One year after surgery, the change in body weight in the org-DA group/mod-DA group was - 8.1%/- 7.0% (P = 0.285), and the change in hemoglobin level was - 5.0%/- 3.9% (P = 0.012). Endoscopic examination at the 1-year follow-up in the mod-DA group showed smaller amounts of food residue (P = 0.008) as well as less residual gastritis (P < 0.001) than in the org-DA group. The modified DA method can be performed safely with a complication rate comparable with the original DA method. Furthermore, better postoperative function is expected because of its more natural anatomy and physiology resulting from the modified method.