title: Intracorporeal circular-stapled Billroth I anastomosis in single-incision laparoscopic distal gastrectomy.
abstract: OBJECTIVE
  The intracorporeal anastomotic procedure is one of the most difficult components in single-incision laparoscopic gastrectomy. We describe a simple surgical technique for intracorporeal circular-stapled Billroth I gastroduodenostomy with transumbilical introduction of the instrument.
  
  
  METHODS
  After standard laparoscopic mobilization of the distal stomach using a mini-loop retractor (diameter, 2 mm), a semi-circumference duodenotomy was made just distal to the pyloric ring. The anvil of a circular stapling device, secured with a Prolene suture with a needle, was introduced via the duodenotomy. The suture was advanced anteriorly such that an anvil shaft transfixed the anterior duodenal wall. The duodenum was staple-transected at this point, and the anvil shaft was removed from the duodenum by pulling the thread. The anvil shaft was advanced against the posterior wall of the stomach and tightly grasped by the mini-loop retractor to avoid slippage. After the cartridge-carrying instrument was introduced transumbilically with the pneumoperitoneum maintained using a surgical glove, the anvil shaft was connected with the center rod of the instrument under fine laparoscopic view. The instrument was fired to complete the circular-stapled gastroduodenostomy.
  
  
  RESULTS
  We employed this technique in 20 patients. Neither postoperative complications, including anastomotic leakage and stricture, nor postoperative mortality were observed.
  
  
  CONCLUSIONS
  Our modified technique for intracorporeal Billroth I reconstruction in single-incision laparoscopic distal gastrectomy is safe and feasible. This technique could be an attractive surgical option for all laparoscopic reconstructive procedures using circular stapling devices.
authors: Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035, Japan. ohmori@oph.gr.jp
authors: Takeshi
authors: T
authors: Omori
authors: Kouji
authors: K
authors: Tanaka
authors: Masayuki
authors: M
authors: Tori
authors: Shigeyuki
authors: S
authors: Ueshima
authors: Hiroki
authors: H
authors: Akamatsu
authors: Toshirou
authors: T
authors: Nishida
mesh_terms: D004385:Duodenostomy / Q000379:methods*; D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008488:Medical Illustration; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods; D013536:Suture Techniques