INTACT for Billroth I reconstruction after LDG

Hirotaka Sasada, PhD1, Fumihiro Wakayama1, Takehiro Sakai1, Kohji Nagao1, Tadashi Iwabuchi1, Nobuo Yagihashi1, Shunnichi Takaya1, Juno Nagayama2, Tsuyoshi Murakami3. 1Tsugaru General Hospita., 2Tokiwakai Hospital, 3Hirosaki University

Introduction: Before we performed hemi double stapling technique (DST) after laparoscopic distal gastrectomy (LDG). The method needs about 5cm laparotomy on epigastrium. Now for complete laparoscopic surgery we performe intracorporeal triangular Billroth I (B-I) anastomotic technique after laparoscopic distal gastrectomy (LDG) for gastric cancer as Dr.Takeshi Omori’s method. We report the result.

Methods: After LDG, we make a small incision to remnant stomach and duodenum. We perform anastomosis with linear stapler, close the common hole with linear stapler, and remove the stump of duodenum with linear stapler. Then the anastomosis is completed.

Results: Between January 2014 and Aug 2015, the number of LDG was 32 patients. Among 32 examples B-I anastomosis was 10, Billroth II (B-II) anastomosis was 9, and Roux-Y anastomosis was 13. 9patients were performed intracorporeal triangular anastomotic technique (INTACT) among 10 B-I patients. Gastric cancer of patients performed INTACT were early stage of gastric cancer. Every operations were performed through 5 access ports. Mean operation time was 271 ± 58 minutes, mean bloodloss was 20.0 ±40.0 mL. Mean postoperative hospital day was 13.1 ± 10.3 days in 8 patients performed INTACT except 1 patient of delayed gastric emptying. Postoperative complication was 1 delayed gastric emptying and 1 lymphorrhea. These 9 patients performed INTACT are compared with nearest 10 patient performed hemi double stapling technique (DST) previous. In 10 patient performed hemi DST mean operation time was 290.0 ± 39.4 minutes, mean blood loss was 76.9 ±75.5 mL. Mean postoperative day was 16.7 ± 18.6 days. Tere is no significant difference between patients performed INTACT and patients performed hemi DST.

Conclusions: Intracorporeal triangular Billroth I anastomotic technique is useful as B-I reconstruction after lanaroscopic distal gastrectomy.

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