title: Evaluation of the delta-shaped anastomosis in laparoscopic distal gastrectomy: midterm results of a comparison with Roux-en-Y anastomosis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 < 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.
  
  
  CONCLUSIONS
  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.
authors: Division of Endoscopic Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan, kitagami@phoenix-c.or.jp.
authors: Hidehiko
authors: H
authors: Kitagami
authors: Mamoru
authors: M
authors: Morimoto
authors: Masashi
authors: M
authors: Nozawa
authors: Kenichi
authors: K
authors: Nakamura
authors: Shinya
authors: S
authors: Tanimura
authors: Katsuhiko
authors: K
authors: Murakawa
authors: Yoshihiro
authors: Y
authors: Murakami
authors: Kenji
authors: K
authors: Kikuchi
authors: Hajime
authors: H
authors: Ushigome
authors: Leo
authors: L
authors: Sato
authors: Minoru
authors: M
authors: Yamamoto
authors: Yasunobu
authors: Y
authors: Shimizu
authors: Tetsushi
authors: T
authors: Hayakawa
authors: Moritsugu
authors: M
authors: Tanaka
authors: Satoshi
authors: S
authors: Hirano
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical / Q000379:methods*; D001655:Bile Reflux / Q000209:etiology; D016063:Blood Loss, Surgical; D004377:Dumping Syndrome / Q000209:etiology; D004385:Duodenostomy; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000601:surgery