title: Triangulating stapling technique for anastomosis in laparoscopy-assisted pylorus-preserving gastrectomy.
abstract: OBJECTIVE
  The anastomosis performed during laparoscopy-assisted pylorus-preserving gastrectomy (PPG) is usually handsewn; however, the technique is sometimes difficult because it is done through a small incision and the level of skill of each operator may vary. The present study describes a triangulating stapling technique used during an anastomosis in laparoscopy-assisted pylorus-preserving gastrectomy.
  
  
  METHODS
  The 80-mm stapler was used 3 times for the triangulating stapling technique. The posterior walls, including the stay sutures, were joined by firing the stapler, and the anterior stomach ends were stapled in an everting fashion using two firings of the stapler. Both the anterior staple lines should overlap in the middle. Patient demographics and the operative data were examined.
  
  
  RESULTS
  The triangulating stapling technique was performed during laparoscopy-assisted PPG in 9 patients. The median time for the anastomosis during laparoscopy-assisted PPG using the triangulating stapling technique was 19.0 min (16.0-31.0). Postoperative complications, including gastric stasis and anastomotic failure, were not found in any of the present patients.
  
  
  CONCLUSIONS
  The triangulating stapling technique using a linear stapler is a safe and reliable technique to perform and can be easily conducted in a short time. We therefore consider it a useful anastomosis method for laparoscopy-assisted pylorus-preserving gastrectomy, even by unskilled surgeons.
authors.affiliation: Department of Gastrointestinal Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Souya
authors.initials: S
authors.lastname: Nunobe
authors.forename: Takashi
authors.initials: T
authors.lastname: Kiyokawa
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Hatao
authors.forename: Ikuo
authors.initials: I
authors.lastname: Wada
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Shimizu
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Nomura
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Seto
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002983:Clinical Competence; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011708:Pylorus / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*