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)

Tokuhara,Takaya; Nakata,Eiji; Higashino,Masayuki

doi:10.3892/ol.2023.13940

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)

Authors:
- Takaya Tokuhara
- Eiji Nakata
- Masayuki Higashino
View Affiliations

Affiliations: Department of Gastroenterology, Otori Stomach and Intestines Hospital, Sakai, Osaka 593‑8311, Japan, Department of Gastroenterology, Hokusetsu‑Miki Hospital, Suita, Osaka 564‑0002, Japan
Published online on: July 4, 2023 https://doi.org/10.3892/ol.2023.13940
Article Number: 354
Copyright: © Tokuhara et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

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.

View Figures

View References

1	Jayaraman MV, Mayo-Smith WW, Movson JS, Dupuy DE and Wallach MT: CT of the duodenum: An overlooked segment gets its due. Radiographics. 21:S147–S160. 2001. View Article : Google Scholar : PubMed/NCBI
2	Reghunath A, Kabilan K and Mittal MK: Exploring the neglected segment of the intestine: The duodenum and its pathologies. Pol J Radiol. 85:e230–e244. 2020. View Article : Google Scholar : PubMed/NCBI
3	Terra C, Ramos-Andrade D, Sá-Marques I, Brito J, Caseiro-Alves F and Curvo-Semedo L: Duodenal imaging on the spotlight: From A to Z. Insights Imaging. 12:942021. View Article : Google Scholar : PubMed/NCBI
4	Hentati N, Fournier HD, Papon X, Aube C, Vialle R and Mercier P: Arterial supply of the duodenal bulb: An anatomoclinical study. Surg Radiol Anat. 21:159–164. 1999. View Article : Google Scholar : PubMed/NCBI
5	von Trotha KT, Butz N, Grommes J, Binnebösel M, Charalambakis N, Mühlenbruch G, Schumpelick V, Klinge U, Neumann UP, Prescher A and Krones CJ: Vascular anatomy of the small intestine-a comparative anatomic study on humans and pigs. Int J Colorectal Dis. 30:683–690. 2015. View Article : Google Scholar : PubMed/NCBI
6	Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y and Ohtoshi M: Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: New technique of intraabdominal gastroduodenostomy. J Am Coll Surg. 195:284–287. 2002. View Article : Google Scholar : PubMed/NCBI
7	Kanaya S, Kawamura Y, Kawada H, Iwasaki H, Gomi T, Satoh S and Uyama I: The delta-shaped anastomosis in laparoscopic distal gastrectomy: Analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer. 14:365–371. 2011. View Article : Google Scholar : PubMed/NCBI
8	Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH and Park SM: Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: Preliminary experience. Surg Endosc. 22:436–442. 2008. View Article : Google Scholar : PubMed/NCBI
9	Song KY, Park CH, Kang HC, Kim JJ, Park SM, Jun KH, Chin HM and Hur H: Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: Prospective, multicenter study. J Gastrointest Surg. 12:1015–1021. 2008. View Article : Google Scholar : PubMed/NCBI
10	Ikeda O, Sakaguchi Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, Ohga T, Adachi E, Toh Y, Okamura T and Baba Hz: Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc. 23:2374–2379. 2009. View Article : Google Scholar : PubMed/NCBI
11	Kim MG, Kawada H and Kim BS, Kim TH, Kim KC, Yook JH and Kim BS: A totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG) for improvement of the early surgical outcomes in high BMI patients. Surg Endosc. 25:1076–1082. 2011. View Article : Google Scholar : PubMed/NCBI
12	Kinoshita T, Shibasaki H, Oshiro T, Ooshiro M, Okazumi S and Katoh R: Comparison of laparoscopy-assisted and total laparoscopic Billroth-I gastrectomy for gastric cancer: A report of short-term outcomes. Surg Endosc. 25:1395–1401. 2011. View Article : Google Scholar : PubMed/NCBI
13	Noshiro H, Iwasaki H, Miyasaka Y, Kobayashi K, Masatsugu T, Akashi M and Ikeda O: An additional suture secures against pitfalls in delta-shaped gastroduodenostomy after laparoscopic distal gastrectomy. Gastric Cancer. 14:385–389. 2011. View Article : Google Scholar : PubMed/NCBI
14	Kim MG, Kim KC and Kim BS, Kim TH, Kim HS, Yook JH and Kim BS: A totally laparoscopic distal gastrectomy can be an effective way of performing laparoscopic gastrectomy in obese patients (body mass index≥30). World J Surg. 35:1327–1332. 2011. View Article : Google Scholar : PubMed/NCBI
15	Kim DG, Choi YY, An JY, Kwon IG, Cho I, Kim YM, Bae JM, Song MG and Noh SH: Comparing the short-term outcomes of totally intracorporeal gastroduodenostomy with extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer: A single surgeon's experience and a rapid systematic review with meta-analysis. Surg Endosc. 27:3153–3161. 2013. View Article : Google Scholar : PubMed/NCBI
16	Okabe H, Obama K, Tsunoda S, Tanaka E and Sakai Y: Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: A long-term follow-up study. Ann Surg. 259:109–116. 2014. View Article : Google Scholar : PubMed/NCBI
17	Kitagami H, Morimoto M, Nozawa M, Nakamura K, Tanimura S, Murakawa K, Murakami Y, Kikuchi K, Ushigome H, Sato L, et al: Evaluation of the delta-shaped anastomosis in laparoscopic distal gastrectomy: Midterm results of a comparison with Roux-en-Y anastomosis. Surg Endosc. 28:2137–2144. 2014. View Article : Google Scholar : PubMed/NCBI
18	Lee HH, Song KY, Lee JS, Park SM and Kim JJ: Delta-shaped anastomosis, a good substitute for conventional Billroth I technique with comparable long-term functional outcome in totally laparoscopic distal gastrectomy. Surg Endosc. 29:2545–2552. 2015. View Article : Google Scholar : PubMed/NCBI
19	Jeong O, Jung MR, Park YK and Ryu SY: Safety and feasibility during the initial learning process of intracorporeal Billroth I (delta-shaped) anastomosis for laparoscopic distal gastrectomy. Surg Endosc. 29:1522–1529. 2015. View Article : Google Scholar : PubMed/NCBI
20	Man-I M, Suda K, Kikuchi K, Tanaka T, Furuta S, Nakauchi M, Ishikawa K, Ishida Y and Uyama I: Totally intracorporeal delta-shaped B-I anastomosis following laparoscopic distal gastrectomy using the Tri-Staple™ reloads on the manual Ultra handle: A prospective cohort study with historical controls. Surg Endosc. 29:3304–3312. 2015. View Article : Google Scholar : PubMed/NCBI
21	Ikeda T, Kawano H, Hisamatsu Y, Ando K, Saeki H, Oki E, Ohga T, Kakeji Y, Tsujitani S, Kohnoe S and Maehara Y: Progression from laparoscopic-assisted to totally laparoscopic distal gastrectomy: Comparison of circular stapler (i-DST) and linear stapler (BBT) for intracorporeal anastomosis. Surg Endosc. 27:325–332. 2013. View Article : Google Scholar : PubMed/NCBI
22	Omori T, Masuzawa T, Akamatsu H and Nishida T: A simple and safe method for Billroth I reconstruction in single-incision laparoscopic gastrectomy using a novel intracorporeal triangular anastomotic technique. J Gastrointest Surg. 18:613–616. 2014. View Article : Google Scholar : PubMed/NCBI
23	Yanagimoto Y, Omori T, Fujiwara Y, Demura K, Jeong-Ho M, Shinno N, Yamamoto K, Sugimura K, Miyata H, Ushigome H, et al: Comparison of the intracorporeal triangular and delta-shaped anastomotic techniques in totally laparoscopic distal gastrectomy for gastric cancer: An analysis with propensity score matching. Surg Endosc. 34:2445–2453. 2020. View Article : Google Scholar : PubMed/NCBI
24	Iwasaki K, Cho H, Ogawa R, Ishida H, Oguri Y, Maezawa Y, Tsuchida K, Nagakawa Y, Katsumata K and Tsuchida A: Comparison of intracorporeal trapezoidal-shaped gastroduodenostomy and delta-shaped anastomosis after laparoscopic distal gastrectomy for gastric cancer: A single-center retrospective study. Surg Laparosc Endosc Percutan Tech. 32:292–298. 2022. View Article : Google Scholar : PubMed/NCBI
25	Chen G, Li W, Yu W, Cen D, Wang X, Luo P, Yan J, Chen G, Zhu Y and Zhu L: Application of overlap gastroduodenostomy in Billroth i anastomosis after totally laparoscopic distal gastrectomy for gastric cancer. Can J Gastroenterol Hepatol. 2022:90949342022. View Article : Google Scholar : PubMed/NCBI
26	Tokuhara T, Nakata E, Tenjo T, Kawai I, Kondo K and Hatabe S: 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. PLoS One. 15:e02301132020. View Article : Google Scholar : PubMed/NCBI
27	Song HM, Lee SL, Hur H, Cho YK and Han SU: Linear-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy. J Gastric Cancer. 10:69–74. 2010. View Article : Google Scholar
28	Jang CE and Lee S: Modified intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: Early experience. Ann Surg Treat Res. 89:306–312. 2015. View Article : Google Scholar : PubMed/NCBI
29	Byun C, Cui LH, Son SY, Hur H, Cho YK and Han SU: Linear-shaped gastroduodenostomy (LSGD): Safe and feasible technique of intracorporeal Billroth I anastomosis. Surg Endosc. 30:4505–4514. 2016. View Article : Google Scholar : PubMed/NCBI
30	Watanabe Y, Watanabe M, Suehara N, Saimura M, Mizuuchi Y, Nishihara K, Iwashita T and Nakano T: Billroth-I reconstruction using an overlap method in totally laparoscopic distal gastrectomy: Propensity score matched cohort study of short- and long-term outcomes compared with Roux-en-Y reconstruction. Surg Endosc. 33:3990–4002. 2019. View Article : Google Scholar : PubMed/NCBI
31	Wang B, Son SY, Shin HJ, Hur H and Han SU: The learning curve of linear-shaped gastroduodenostomy associated with totally laparoscopic distal gastrectomy. J Gastrointest Surg. 24:1770–1777. 2020. View Article : Google Scholar : PubMed/NCBI
32	Kosuge M, Eto K, Hashizume R, Takeda M, Tomori K, Neki K, Mitsumori N and Yanaga K: Which is the safer anastomotic method for colon surgery? -Ten-year results. In Vivo. 31:683–687. 2017. View Article : Google Scholar : PubMed/NCBI
33	Oki E, Tsuda Y, Saeki H, Ando K, Imamura Y, Nakashima Y, Ohgaki K, Morita M, Ikeda T and Maehara Y: Book-binding technique for Billroth I anastomosis during totally laparoscopic distal gastrectomy. J Am Coll Surg. 219:e69–e73. 2014. View Article : Google Scholar : PubMed/NCBI
34	Kim JS, Park EY, Park DJ and Kim GY: Modified book binding technique (MBBT) for intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy: Initial experience. J Gastric Cancer. 19:355–364. 2019. View Article : Google Scholar : PubMed/NCBI
35	Kikuchi S, Kuroda S, Nishizaki M, Kuwada K, Takata N, Kakiuchi Y, Yano S, Noma K, Kagawa S and Fujiwara T: Intracorporeal semi-hand-sewn Billroth I reconstruction in total laparoscopic distal gastrectomy. Asian J Endosc Surg. 14:640–643. 2021. View Article : Google Scholar : PubMed/NCBI
36	Waki Y, Masayoshi O, Sato K and Yagi S: Modification of book-binding technique during totally laparoscopic distal gastrectomy with Billroth I reconstruction. J Minim Access Surg. 18:625–628. 2022. View Article : Google Scholar : PubMed/NCBI
37	Fukunaga T, Ishibashi Y, Oka S, Kanda S, Yube Y, Kohira Y, Matsuo Y, Mori O, Mikami S, Enomoto T and Otsubo T: Augmented rectangle technique for Billroth I anastomosis in totally laparoscopic distal gastrectomy for gastric cancer. Surg Endosc. 32:4011–4016. 2018. View Article : Google Scholar : PubMed/NCBI