Ann Surg Treat Res.  2023 Sep;105(3):172-177. 10.4174/astr.2023.105.3.172.

Intracorporeal modified delta-shaped gastroduodenostomy during 2-port distal gastrectomy: technical aspects and short-term outcomes

• Lee S
• Song JH
• Park SH
• Cho M
• Kim YM
• Hyung WJ
• Kim HI

• KMID: 2545909
• DOI: http://doi.org/10.4174/astr.2023.105.3.172

Abstract

Purpose
Surgeons have become increasingly interested in reduced-port gastrectomy to minimize trauma while maintaining oncologic safety. Although gastroduodenostomy has the benefits of better nutritional outcomes and fewer postoperative complications than other types of reconstruction, gastroduodenostomy is not a preferred option for reducedport distal gastrectomy because of technical difficulties. In this study, we describe our intracorporeal modified deltashaped gastroduodenostomy technique, which is easily applicable during 2-port distal gastrectomy.
Methods
We retrospectively reviewed our database of 30 consecutive patients with gastric cancer who underwent 2-port distal gastrectomy with intracorporeal modified delta-shaped gastroduodenostomy from October 2016 to May 2021. In this reduced-port approach, we used a Tropian Single port (TROPIAN TECH) via a 25-mm transumbilical incision and a 12-mm port at the right flank. All anastomoses were performed using a 60-mm endolinear stapler. We used 3 additional sutures to provide proper traction and support for the anastomosis.
Results
Mean ± standard deviation of operation time was 148.9 ± 34.7 minutes; reconstruction time was 13.2 ± 4.6 minutes; estimated blood loss was 29.3 ± 44.4 mL; and length of hospital stay was 4.5 ± 1.2 postoperative days. A total of 11 patients (36.7%) had a Clavien-Dindo grade I or grade II complication, and there were no grade IIIa or higher complications.
Conclusion
Intracorporeal modified delta-shaped gastroduodenostomy was safely performed via a 2-port approach, resulting in acceptable surgical outcomes and no major complications.

Keyword

Minimally invasive surgical procedures; Gastroenterostomy

Figure

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  Fig. 1 Locations of the Tropian Single port (umbilicus; TROPIAN TECH) and 12-mm port (right flank).

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  Fig. 2 Intracorporeal modified delta-shaped gastroduodenostomy during 2-port distal gastrectomy. (A) A traction suture was added at the middle of artificial lesser curvature line, and the thread was pulled out of the abdomen through the transumbilical port. (B) The endolinear stapler cartridge was inserted into the stomach and rotated to approximate the posterior wall of the stomach and duodenum. (C) The common entry hole was closed while lifting the traction sutures at the anterior and posterior sides of the entry hole. (D) Completed intracorporeal modified delta-shaped gastroduodenostomy.

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