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

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

来源：Surgical Endoscopy and Other Interventional Techniques, 2014, 28(7): 2137-2144.

DOI：10.1007/s00464-014-3445-6

• Delta-shaped anastomosis
• Laparoscopic distal gastrectomy
• Intracorporeal gastroduodenostomy
• Billroth I reconstruction

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. %26lt;br%26gt;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. %26lt;br%26gt;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 %26lt; 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. %26lt;br%26gt;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.

• 出版日期2014-7