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, 9 (7), e102736
eCollection

A Modified Delta-Shaped Gastroduodenostomy in Totally Laparoscopic Distal Gastrectomy for Gastric Cancer: A Safe and Feasible Technique

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A Modified Delta-Shaped Gastroduodenostomy in Totally Laparoscopic Distal Gastrectomy for Gastric Cancer: A Safe and Feasible Technique

Changming Huang et al. PLoS One.

Abstract

Background: The present study introduced a modified delta-shaped gastroduodenostomy (DSG) technique and assessed the safety, feasibility and clinical results of this procedure in patients undergoing totally laparoscopic distal gastrectomy (TLDG) for gastric cancer (GC).

Materials and methods: A total of 102 patients with distal GC undergoing TLDG with modified DSG between January 2013 and December 2013 were enrolled. A retrospective study was performed using a prospectively maintained comprehensive database to evaluate the results of the procedure. Univariate and multivariate analyses were performed to estimate the predictive factors for postoperative morbidity.

Results: The mean operation time was 150.6±30.2 min, the mean anastomosis time was 12.2±4.2 min, the mean blood loss was 48.2±33.2 ml, and the mean times to first flatus, fluid diet, soft diet and postoperative hospital stay were 3.8±1.3 days, 5.0±1.0 days, 7.4±2.1 days and 12.0±6.5 days, respectively. Two patients with minor anastomotic leakage after surgery were managed conservatively; no patient experienced any complications around the anastomosis, such as anastomotic stricture or anastomotic hemorrhage. Univariate analysis showed that age, gastric cancer with hemorrhage and cardiovascular disease combined were significant factors that affected postoperative morbidity (P<0.05). Multivariate analysis found that gastric cancer with hemorrhage was the independent risk factor for the postoperative morbidity (P = 0.042). At a median follow-up of 7 months, no patients had died or experienced recurrent or metastatic disease.

Conclusions: The modified DSG was technically safe and feasible, with acceptable surgical outcomes, in patients undergoing TLDG for GC, and this procedure may be promising in these patients.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Trocar placements for totally laparoscopic distal gastrectomy.
Figure 2
Figure 2. The procedures of modified delta-shaped gastroduodenostomy before closing the common stab incision.
a Diagram showing that the stapler was positioned across the duodenum vertical to the long axis in the predetermined position and fired to transect the duodenum by rotating 90 degrees from back to front. b Intraoperative image showing that the stapler was positioned across the duodenum vertical to the long axis in the predetermined position and fired to transect the duodenum by rotating 90 degrees from back to front. c Diagram showing that the stomach was resected by successively transecting from the greater curvature to the lesser curvature with two staplers. d Intraoperative image showing that the stomach was resected by successively transecting from the greater curvature to the lesser curvature with two staplers. e Diagram showing that the stapler was positioned to join the posterior walls together. f Intraoperative image showing that the stapler was positioned to join the posterior walls together. g Diagram showing the V-shaped anastomosis on the posterior wall. h Intraoperative image showing the V-shaped anastomosis on the posterior wall.
Figure 3
Figure 3. The differences between the conventional delta-shaped gastroduodenostomy (DSG) and the modified DSG.
a Diagram showing that three sutures were added to each end of the common stab incision and the cutting edges of the stomach and duodenum to obtain an involution and pull in the conventional DSG. b Diagram showing the completed involution of the common stab incision using the instruments of the surgeon and assistant with the blind angle of the duodenum being pulled up into the stapler in the modified DSG. c Diagram showing the completed conventional DSG with two intersections of the gastroduodenal cutting edge and the common closed edge. d Diagram showing the completed modified DSG with only one intersection of the gastric cutting edge and the common closed edge. e Intraoperative image showing the completed involution of the common stab incision using the instruments of the surgeon and assistant with the blind angle of the duodenum being pulled up into the stapler in the modified DSG. f Intraoperative image showing the completed inverted T-shaped appearance of anastomosis in the modified DSG.
Figure 4
Figure 4. The film of upper gastrointestinal radiography.
The film of upper gastrointestinal radiography with diatrizoate meglumine as the contrast medium on postoperative day 7 for one patient underwent the modified delta-shaped gastroduodenostomy. The inner diameter of the anastomosis was measured the length of the white arrow as shown in the figure.
Figure 5
Figure 5. The gastroscope image of one patient underwent the modified delta-shaped gastroduodenostomy on postoperative 3 months.

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Publication types

Grant support

The authors were funded by the National Key Clinical Specialty Discipline Construction program of China (No. [2012]649). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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