title: A new intracorporeal Billroth II stapled anastomosis technique in totally laparoscopic distal gastrectomy.
abstract: BACKGROUND
  We introduced a new, safe and simple intracorporeal Billroth II (B-II) gastrojejunostomy technique using laparoscopic linear staplers with totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. We further compared the short-term operative outcomes between intracorporeal B-II gastrojejunostomy with TLDG and extracorporeal B-II gastrojejunostomy with laparoscopy-assisted distal gastrectomy (LADG).
  
  
  METHODS
  From January 01, 2012 to January 31, 2013, a total of 36 patients with gastric cancer underwent TLDG and LADG. Overall, 11 patients underwent intracorporeal B-II gastrojejunostomy with TLDG, and 25 patients underwent a mini-laparotomy incision for extracorporeal B-II anastomosis with LADG. Perioperative parameters, including patient and tumor characteristics, short-term postoperative outcomes, and anastomosis-related complications, were analyzed to compare the two operations.
  
  
  RESULTS
  The time to first flatus, the time on a liquid diet, and the mean postoperative length of hospital stay were significantly different between the groups (P < 0.05). In the TLDG group, the postoperative time to first flatus and the mean postoperative length of hospital stay were significantly shorter than in the LADG group (2.6 ± 0.20 vs. 3.8 ± 0.1 days; 10 ± 1.84 vs. 12.7 ± 3.35 days). However, the operation-related costs were significantly greater for totally laparoscopic distal gastrectomy (P < 0.001). The mean number of staples used in TLDG was six compared with four in LADG.
  
  
  CONCLUSIONS
  Our new intracorporeal B-II anastomosis method using laparoscopic linear staplers with TLDG was safe, feasible, and minimally invasive compared with extracorporeal B-II gastrojejunostomy with LADG. At the same time, one of its characteristics of our technique is to avoid stricturing of the efferent loop or afferent loop of the jejunum when the entry hole is closed with a stapler.
authors.affiliation: Department of General Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China, 1939618043@qq.com.
authors.forename: Chaojun
authors.initials: C
authors.lastname: Zhang
authors.forename: Weidong
authors.initials: W
authors.lastname: Xiao
authors.forename: Kang
authors.initials: K
authors.lastname: Chen
authors.forename: Zhicao
authors.initials: Z
authors.lastname: Zhang
authors.forename: Guangsheng
authors.initials: G
authors.lastname: Du
authors.forename: Enlai
authors.initials: E
authors.lastname: Jiang
authors.forename: Hua
authors.initials: H
authors.lastname: Yang
mesh_terms: D000368:Aged; D003251:Constriction, Pathologic / Q000517:prevention & control; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods; D005763:Gastroenterostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000473:pathology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling