title: An effective duodenum bulb mobilization for extracorporeal Billroth I anastomosis of laparoscopic gastrectomy.
abstract: BACKGROUND
  Extracorporeal circular-stapled Billroth I (B-I) anastomosis is difficult in patients with obesity, a large body shape, or small remnant stomach, as it requires the duodenal stump to be lifted outside of the wound. The aim of this study was to evaluate the feasibility of circular-stapled B-I reconstruction for laparoscopy-assisted distal gastrectomy (LADG) with effective duodenal mobilization.
  
  
  METHODS
  Between March 2005 and December 2007, 199 patients with early gastric cancer underwent LADG with B-I reconstruction in the Department of Gastrointestinal Surgery at the Cancer Institute. The greater omentum, comprised of four membrane layers, was completely dissected for effective duodenal bulb mobilization to allow easy performance of extracorporeal end-to-end gastroduodenostomy. Several clinicopathophysiological features relating to anastomosis complications, including anastomotic leakage, stenosis, bleeding, and ulcers, were evaluated.
  
  
  RESULTS
  The success rate of extracorporeal circular-stapled B-I anastomosis was 100% for the 199 patients, 24% of whom had a body mass index greater than 25. The rate of anastomosis-related postoperative complications was 2%. Anastomotic leakage was not observed in this study. Anastomotic stenosis was observed in 2 (1%) patients, anastomotic bleeding was observed in 1 (0.5%) patient, and anastomotic ulcer was diagnosed in 1 (0.5%) patient. All these complications were managed conservatively. There was no postoperative mortality.
  
  
  CONCLUSIONS
  Feasible duodenal bulb mobilization by complete dissection of the greater omentum allows easy performance of extracorporeal B-I anastomosis and minimizes complications related to anastomosis in LADG.
authors.affiliation: Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo 135-8550, Japan. naoki.hiki@jfcr.or.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiki
authors.forename: Testsu
authors.initials: T
authors.lastname: Fukunaga
authors.forename: Masanori
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Ohyama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yamada
authors.forename: Akio
authors.initials: A
authors.lastname: Saiura
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D004386:Duodenum / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome
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