title: The technical outcomes of delta-shaped anastomosis in laparoscopic distal gastrectomy: a single-center safety and feasibility study.
abstract: The indications for laparoscopic gastrectomy for early stomach cancer have spread worldwide, and the short-term outcomes have been favorable. Intraabdominal delta-shaped gastroduodenostomy using endoscopic linear staplers, a technique which was developed by Kanaya et al. is one of the feasible reconstructive procedures. Pure laparoscopic surgery is reported to be associated with several intraoperative and postoperative advantages in comparison with laparoscopy-assisted surgery. However, the clinical results remain uncertain. The present study aimed to evaluate both the technical feasibility and safety of delta-shaped anastomosis with LDG according to the short-term outcomes.
  
  
  
  The study group was composed of 229 patients who underwent delta-shaped anastomosis with LDG at Gifu University School of Medicine from December 2004 to December 2014.
  
  
  
  The median total operative blood loss and operative time were 20 ml and 277 min, respectively. Postoperative complications were detected in 20 (8.7 %) patients. The complications included: anastomotic stenosis, n = 3 (1.3 %); anastomotic leakage, n = 3 (1.3 %); pancreatic injury, n = 8 (3.5 %); anastomotic ulcer, n = 1 (0.4 %); bowel obstruction, n = 1 (0.4 %); abdominal abscess, n = 1 (0.4 %); lymphorrhea, n = 1 (0.4 %); cardiac failure, n = 1 (0.4 %); and infection, n = 1 (0.4 %). The complications were classified as grade 2, n = 4 (1.7 %); grade 3a, n = 12 (5.2 %); grade 3b, n = 4 (1.7 %); and grade 4 and 5, n = 0 (0 %).
  
  
  
  The findings of the present study indicate the safety of Kanaya's procedure and that it should provide better outcomes in patients who undergo intracorporeal gastroduodenostomy after laparoscopic distal gastrectomy.
authors.affiliation: Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Matsuhashi
authors.affiliation: Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yamaguchi
authors.affiliation: Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Okumura
authors.affiliation: Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tanahashi
authors.affiliation: Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsui
authors.affiliation: Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Imai
authors.affiliation: Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Osada
authors.affiliation: Surgical Oncology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan. kyoshida@gifu-u.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D016063:Blood Loss, Surgical; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications
keywords: Delta-shaped anastomosis; Intracorporeal gastroduodenostomy; Laparoscopic gastrectomy