title: [Clinical research of delta-shaped anastomosis technology in laparoscopic distal gastrectomy and digestive tract reconstruction].
abstract: OBJECTIVE
  To evaluate the feasibility and safety of the delta-shaped anastomosis in laparoscopic distal gastrectomy and digestive tract reconstruction.
  
  
  METHODS
  Clinical data of 34 gastric cancer patients undergoing laparoscopic distal gastrectomy with the delta-shaped anastomosis for digestive tract reconstruction (delta-shaped group) and 83 gastric cancer patients undergoing laparoscopic distal gastrectomy with Billroth I( for digestive tract reconstruction (Billroth group) by same surgeon team from July 2013 to July 2015 at the Department of Digestive Surgery, Affiliated Tumor Hospital of Shanxi Medical University were retrospectively analyzed. Data of two groups were compared.
  
  
  RESULTS
  Age, gender, tumor stage were not significantly different between the two groups(all P>0.05). Operation time of the first 15 cases in delta-shaped group was longer than that in Billroth group [(254.7±35.4) min vs. (177.8±33.0) min, t=11.190, P=0.000], while after above 15 cases, the operation time of delta-shaped group was significantly shorter than that of Billroth group [(142.1±14.6) min vs. (177.8±33.0) min, t=-4.109, P=0.001]. Delta-shaped group had less blood loss during operation [(87.1±36.7) ml vs. (194.0±55.1) ml, t=-10.268, P=0.000], and shorter length of incision [(4.1±0.4) cm vs. (6.1±1.0) cm, t=-10.331, P=0.000] than Billroth group. Compared with Billroth group, delta-shaped group presented faster postoperative bowel function return [(2.8±0.6) d vs. (3.3±0.5) d, t=-3.755, P=0.000], earlier liquid food intake [(7.4±1.5) d vs. (8.1±1.7) d, t=-4.135, P=0.000], earlier ambulation [(4.0±1.6) d vs. (6.8±1.4) d, t=-7.197, P=0.000] and shorter postoperative hospital stay [(12.6±1.9) d vs.(13.6±2.0) d, t=-20.149, P=0.000]. Morbidity of postoperative complication was 5.9%(2/34) in delta-shaped group, including anastomotic fistula in 1 case and incision infection in 1 case, and 6.0%(5/83) in Billroth group, including anastomotic fistula, incision infection, anastomotic stricture and dumping syndrome, without significant difference(P>0.05). Difference value of total protein and albumin between pre-operation and post-operation, and average decreased value of total protein, albumin, body weight between pre-operation and postoperative 6-month were not significantly different between two groups(all P>0.05). As for patients with BMI > 25 kg/m2, compared to Billroth group, delta-shaped group presented less blood loss during operation [(94.1±36.7) ml vs. (203.0±55.1) ml, t=-10.268, P=0.000], lower injective dosage of postoperative analgesics [(1.9±1.1) ampule vs.(3.3±2.0) ampule, t=-2.188, P=0.032], faster intestinal recovery [(2.9±0.7) d vs. (3.2±0.9) d, t=-3.755, P=0.009], shorter hospital stay [(10.5±1.2) d vs. (11.7±1.5) d, t=-2.026, P=0.004], and lower morbidity of postoperative complication [7.1%(1/14) vs. 13.6%(3/22), χ2=4.066, P=0.031].
  
  
  CONCLUSIONS
  In laparoscopic distal gastrectomy and digestive tract reconstruction, the delta-shaped anastomosis is safe and feasible, especially suitable for obese patients.
authors.affiliation: Department of General Surgery, The First Hospital of Yulin, Yulin 719000, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Gao
authors.affiliation: Department of Digestive Surgery, Affiliated Tumor Hospital of Shanxi Medical University, Taiyuan 030013, China.
authors.forename: Qingxing
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Digestive Surgery, Affiliated Tumor Hospital of Shanxi Medical University, Taiyuan 030013, China. asdjh666@163.com.
authors.forename: Jianhong
authors.initials: J
authors.lastname: Dong
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D057186:Comparative Effectiveness Research; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology; D003672:Defecation; D016154:Digestive System Fistula / Q000453:epidemiology / Q000209:etiology; D004326:Drinking; D004377:Dumping Syndrome / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D005763:Gastroenterostomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D020127:Recovery of Function; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery; D000072836:Surgical Wound; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome