Open Access

An option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: A single‑layer suturing technique for the stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures

  • Authors:
    • Takaya Tokuhara
    • Eiji Nakata
    • Toshiyuki Tenjo
    • Isao Kawai
    • Keisaku Kondo
    • Hirofumi Ueda
    • Atsushi Tomioka
  • View Affiliations

  • Published online on: October 31, 2017     https://doi.org/10.3892/ol.2017.7306
  • Pages:229-234
  • Copyright: © Tokuhara et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

We report an option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. We detail a single‑layer suturing technique for the endoscopic linear stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures. From June 2013 to February 2017, we performed TLDG with delta‑shaped gastroduodenostomy in 20 patients with gastric cancer. The linear stapler was closed and fired to attach the posterior walls of the remnant stomach and the duodenum together. After creating a good view of the greater curvature side of the entry hole for the stapler by retracting the knotted suture on the lesser curvature side toward the ventral side, we performed single‑layer entire‑thickness continuous suturing of this hole using a 15‑cm‑long barbed suture running from the greater curvature side to the lesser curvature side. We placed the second and third stitches between the seromuscular layer of the remnant stomach and the entire‑thickness layer of the duodenum while suturing the duodenal mucosa as minutely as possible. In addition, we routinely added one or two entire‑thickness knotted sutures at the site near the greater curvature side. We placed similar additional knotted sutures at the site with a broad pitch. TLDG with this reconstruction technique was successfully performed in all patients with no occurrences of anastomotic leakage or intraabdominal abscess around the anastomosis. It is suggested that this method can be one option for delta‑shaped gastroduodenostomy in TLDG due to its cost-effectiveness and feasibility.

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January 2018
Volume 15 Issue 1

Print ISSN: 1792-1074
Online ISSN:1792-1082

2016 Impact Factor: 1.39
Ranked #68/217 Oncology
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APA
Tokuhara, T., Nakata, E., Tenjo, T., Kawai, I., Kondo, K., Ueda, H., & Tomioka, A. (2018). An option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: A single‑layer suturing technique for the stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures. Oncology Letters, 15, 229-234. https://doi.org/10.3892/ol.2017.7306
MLA
Tokuhara, T., Nakata, E., Tenjo, T., Kawai, I., Kondo, K., Ueda, H., Tomioka, A."An option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: A single‑layer suturing technique for the stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures". Oncology Letters 15.1 (2018): 229-234.
Chicago
Tokuhara, T., Nakata, E., Tenjo, T., Kawai, I., Kondo, K., Ueda, H., Tomioka, A."An option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: A single‑layer suturing technique for the stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures". Oncology Letters 15, no. 1 (2018): 229-234. https://doi.org/10.3892/ol.2017.7306