title: Safety and feasibility during the initial learning process of intracorporeal Billroth I (delta-shaped) anastomosis for laparoscopic distal gastrectomy.
abstract: BACKGROUND
  Intracorporeal Billroth I (ICBI) (delta-shaped) anastomosis is being increasingly used for laparoscopic distal gastrectomy. However, few studies have focused on the safety and feasibility of adopting this new technique. The present study aimed to review the surgical outcomes after the initial experience of performing ICBI anastomosis and to evaluate whether this technique can be safely adopted without increasing operative risk during the early learning process.
  
  
  METHODS
  Forty-two consecutive patients who underwent ICBI anastomosis with laparoscopic distal gastrectomy by a single surgeon were enrolled, and their operative outcomes and hospital course were compared with those of 179 patients who underwent conventional extracorporeal Billroth I (ECBI) anastomosis by the same operator. The learning curve was assessed by evaluating the moving average of anastomosis time.
  
  
  RESULTS
  The operating time in the ICBI group was significantly longer than that in the ECBI group (142 vs. 116 min, p < 0.001). However, there were no significant differences in the postoperative hospital course such as gas passage, diet initiation, postoperative fever, and hospital stay between the two groups. Postoperative morbidity did not significantly differ between the ICBI and ECBI groups (7.1 vs. 12.3 %, p = 0.428). No anastomosis-related complications occurred in the ICBI group. The mean anastomosis time for ICBI anastomosis was 24 ± 5 min, and the anastomosis average time curve showed that it reached a plateau approximately after the 14th case.
  
  
  CONCLUSIONS
  ICBI anastomosis has a steep learning curve without increasing operative risk in the early learning process, when performed by experienced laparoscopic surgeons. The technical feasibility and clinical advantages of intracorporeal anastomosis need to be proven in future clinical trials.
authors.affiliation: Department of Surgery, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-Do, South Korea, surgeonjeong@gmail.com.
authors.forename: Oh
authors.initials: O
authors.lastname: Jeong
authors.forename: Mi Ran
authors.initials: MR
authors.lastname: Jung
authors.forename: Young Kyu
authors.initials: YK
authors.lastname: Park
authors.forename: Seong Yeop
authors.initials: SY
authors.lastname: Ryu
mesh_terms: D004502:Education, Medical, Continuing; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000193:education* / Q000379:methods; D005763:Gastroenterostomy / Q000193:education* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D013274:Stomach Neoplasms / Q000601:surgery*