J Gastric Cancer.  2019 Sep;19(3):355-364. 10.5230/jgc.2019.19.e30.

Modified Book Binding Technique (MBBT) for Intracorporeal Gastroduodenostomy in Totally Laparoscopic Distal Gastrectomy: Initial Experience

• Kim JS
• Park EY
• Park DJ
• Kim GY

• KMID: 2458834
• DOI: http://doi.org/10.5230/jgc.2019.19.e30

Abstract

Totally laparoscopic distal gastrectomy (TLDG) frequently involves the use of delta shaped gastroduodenostomy (DSG) for intracorporeal anastomosis. However, DSG has some drawbacks, and the book binding technique (BBT) was developed as a new technique to overcome these drawbacks. Subsequently, this technique was further improved with the development of modified book binding technique (MBBT). This study evaluated the safety and feasibility of MBBT in patients undergoing TLDG. Thirty-three patients who underwent TLDG with MBBT were retrospectively evaluated. The mean operation time was 277.6±37.1 minutes, including 51.9±15.7 minutes for reconstruction. Two patients had anastomosis-related complications, one patient with stricture after leakage and 1 patient with stenosis. The former patient was treated with endoscopic balloon dilatation, and the latter was managed conservatively; neither required re-operation. MBBT is a safe and feasible technique, with acceptable surgical outcomes. It may be a good alternative option for the treatment of intracorporeal anastomosis in patients undergoing TLDG.

Keyword

Gastric cancer; Gastrectomy; Laparoscopy; Surgical anastomosis

MeSH Terms

Anastomosis, Surgical
Constriction, Pathologic
Dilatation
Gastrectomy*
Humans
Laparoscopy
Retrospective Studies
Stomach Neoplasms

Figure

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  Fig. 1 (A) A small hole was created on the superior edge of the duodenal transection line. (B) The remnant stomach and the duodenal stump were attached by interrupted sutures. (C) Small entry holes were created on the greater curvature side of the remnant stomach and the duodenal stump. (D) The cartridge was inserted into the remnant stomach and the anvil was inserted into the duodenal stump until the tip protruded. (E) The anterior wall of the anastomosis line between the duodenum and the stomach, and the transection lines on the remnant stomach along the anastomosis line were resected.

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  Fig. 2 (A) The open anterior wall of the anastomosis was closed by hand sewing. (B) Gambee method using Endo-stitch (Medtronic Ltd, Dublin, Ireland). (C) Continuous suture using 3-0 V-loc 180 (Medtronic Ltd). (D) Final view of the anastomosis.

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  Fig. 3 (A) Upper gastrointestinal series using gastrograffin on postoperative day 5, showing no anastomosis leakage or stricture. (B) Endoscopic findings 6 months after surgery.

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