Masazumi Sakaguchi, MD, PhD, Norihiro Shimoike, MD, Shin Akagawa, MD, PhD, Seiichiro Kanaya, MD, PhD. Osaka Red Cross Hospital
Background: Since its development, delta-shaped anastomosis (DA) using only endoscopic liner staplers has been widely used during laparoscopic gastroduodenostomy. Herein, we report our DA technique, and short- and mid-term outcomes of 358 consecutive DA cases.
Technique: DA applies functional-end-to-end anastomosis in gastroduodenostomy. By using only liner staplers, a good visual field can be achieved during the procedure, thus ensuring safety. First, a V-shaped anastomosis was created between the remnant stomach and duodenal cut end by firing a 45-mm endoscopic liner stapler. The resultant entry hole was closed by firing either one 60-mm or two 45-mm liner staplers. It is extremely crucial that the operator, assistant, and camera operator work in concert during this procedure.
Methods: We retrospectively identified 358 consecutive patients with gastric cancer who underwent DA from April 2011 to March 2018. We extracted data pertaining to the patient ages, BMIs, postoperative diet start dates, and complications associated with DA.
Results: The median follow-up period was 862 [interquartile range (IQR): 1380–408] days. The median patient age and BMI were 69 (IQR: 62–76) years and 22.6 (IQR: 24.8–20.7), respectively. The median postoperative diet start date was postoperative day 4 (IQR: 4–5 days). Complications of Clavien–Dindo grade 2 or greater included six cases of leakage (1.68%), three of delayed gastric emptying (0.84%), and one of bleeding (0.28%). No patients experienced anastomotic stenosis.
Conclusion: DA is a safe, feasible, and effective procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94349
Program Number: P642
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster