Evaluation of the delta-shaped anastomosis in laparoscopic distal gastrectomy: Midterm results of a comparison with Roux-en-Y anastomosis

Hidehiko Kitagami, Mamoru Morimoto, Masashi Nozawa, Kenichi Nakamura, Shinya Tanimura, Katsuhiko Murakawa, Yoshihiro Murakami, Kenji Kikuchi, Hajime Ushigome, Leo Sato, Minoru Yamamoto, Yasunobu Shimizu, Tetsushi Hayakawa, Moritsugu Tanaka, Satoshi Hirano

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Abstract

Background: Various methods of reconstruction after laparoscopic distal gastrectomy (LDG) have been developed and published, whereas only a limited number of reports are available on the utility of the delta-shaped anastomosis (Delta). This study compared Delta and Roux-en-Y anastomoses (RY), with the aim to clarify the utility of Delta. Methods: Stage 1 gastric cancer patients who had undergone LDG with Delta (group D, n = 68) and those who had undergone LDG with RY (group RY, n = 60) were compared in terms of operative outcomes, postoperative clinical symptoms, gastrointestinal fiberscopic findings, and changes in body weight. Results: Both the operative and anastomotic times were significantly shorter in group D (230 and 13 min, respectively) than in group RY (258 and 38 min, respectively) (p < 0.001). Among the complications observed at the anastomotic site, obstruction was seen in one group D patient and two group RY patients but was relieved with conservative management. Postoperative clinical symptoms were reported for 26.4 % of the group D patients but had decreased to 5.9 % 1 year later. Group RY yielded similar results. Upper gastrointestinal fiberscopy performed 1 year postoperatively showed no intergroup differences in the incidence of gastritis or residual retention and a significantly more frequent occurrence of bile reflux in group D. Postoperative weight changes did not differ between the two groups. Conclusions: Delta reconstruction after LDG is a safe and effective procedure that is totally laparoscopic, less time consuming, and associated with a favorable postoperative course and a better quality of life.

Original languageEnglish
Pages (from-to)2137-2144
Number of pages8
JournalSurgical endoscopy
Volume28
Issue number7
DOIs
Publication statusPublished - 07-2014

All Science Journal Classification (ASJC) codes

  • Surgery

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    Kitagami, H., Morimoto, M., Nozawa, M., Nakamura, K., Tanimura, S., Murakawa, K., Murakami, Y., Kikuchi, K., Ushigome, H., Sato, L., Yamamoto, M., Shimizu, Y., Hayakawa, T., Tanaka, M., & Hirano, S. (2014). Evaluation of the delta-shaped anastomosis in laparoscopic distal gastrectomy: Midterm results of a comparison with Roux-en-Y anastomosis. Surgical endoscopy, 28(7), 2137-2144. https://doi.org/10.1007/s00464-014-3445-6