title: Staple-Line Reinforcement of the Duodenal Stump With Intracorporeal Lembert's Sutures in Laparoscopic Distal Gastrectomy With Roux-en-Y Reconstruction for Gastric Cancer.
abstract: OBJECTIVE
  We report a duodenal stump reinforcement procedure in laparoscopic distal gastrectomy with Roux-en-Y reconstruction.
  
  
  METHODS
  We retrospectively reviewed the data of 223 patients who underwent laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer. We compared 2 groups: group NR (not reinforced, n=102, June 2009 to December 2011) when we did not perform reinforcement of the duodenal stump, and group R (reinforced, n=121, January 2012 to July 2014) when we did the reinforcement. The duodenum was divided with an endoscopic linear stapler. In group R, the duodenal staple line was reinforced by hand-sewn Lembert's sutures.
  
  
  RESULTS
  There were no significant differences between group NR and R in patients' characteristics. Duodenal stump leakage occurred in 2 patients in group NR (2.0%). By contrast, in R group, no patients had duodenal stump leakage or fistula.
  
  
  CONCLUSIONS
  Duodenal stump leakage can be avoided by using reinforcement with Lembert's sutures.
authors.affiliation: *Department of Surgery, Kansai Medical University †Department of Gastrointestinal Surgery, Kansai Medical Hirakata Hospital, Osaka, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Inoue
authors.forename: Taku
authors.initials: T
authors.lastname: Michiura
authors.forename: Junichi
authors.initials: J
authors.lastname: Fukui
authors.forename: Hiromi
authors.initials: H
authors.lastname: Mukaide
authors.forename: Takashi
authors.initials: T
authors.lastname: Ozaki
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Miki
authors.forename: Toshinori
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Masaharu
authors.initials: M
authors.lastname: Oishi
authors.forename: Ryo
authors.initials: R
authors.lastname: Inada
authors.forename: Tomoko
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamada
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yanagimoto
authors.forename: Songtae
authors.initials: S
authors.lastname: Kim
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.forename: Masaki
authors.initials: M
authors.lastname: Kaibori
authors.forename: Masanori
authors.initials: M
authors.lastname: Kon
authors.forename: Madoka
authors.initials: M
authors.lastname: Hamada
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods; D013536:Suture Techniques