Influence of technical errors on short-term and one-year outcomes after intracorporeal delta-shaped Billroth I anastomosis following minimally invasive distal gastrectomy: a single-center retrospective study

Background: Intracorporeal delta-shaped Billroth I (B-I) anastomosis following minimally invasive distal gastrectomy (DG) is a simple and highly reproducible gastroduodenostomy procedure. This study aimed to identify the technical pitfalls of this procedure and assess their influence on one-year outcomes. Methods: This was a retrospective study including patients who underwent delta-shaped B-I anastomosis following minimally invasive DG at our institution between 2008 and 2022. Delta-shaped B-I anastomosis was performed by adhering to five fundamental elements. Data were collected from our prospectively maintained database and analyzed retrospectively. Intra- and postoperative complications were reviewed, and video analysis was performed to identify technical errors associated with these complications. One-year outcomes, including nutritional status and endoscopic findings, were compared between patients with and without complications within 30 days after surgery. Results: A total of 749 patients were included in this study. A total of 36 operating surgeons were involved. Intraoperative anastomotic complications occurred in 0.8% of patients, mainly due to technical issues during linear stapling. Postoperative anastomosis-related complications occurred in 2.1% of patients, with anastomotic leakage, stricture, and delayed gastric emptying rates of 0.9%, 0.3%, and 0.9%, respectively. Most complications were managed conservatively or endoscopically. No late-onset strictures were observed at postoperative year 1, and no significant differences in nutritional and endoscopic findings were observed between patients with and without complications. Conclusion: When performed according to five fundamental technical principles, intracorporeal delta-shaped B-I anastomosis following minimally invasive DG proved to be a safe, reproducible procedure associated with favorable one-year outcomes.