Influence of technical errors on short-term and one-year outcomes after intracorporeal delta-shaped Billroth I anastomosis following minimally invasive distal gastrectomy: a single-center retrospective study.

BACKGROUND

Intracorporeal delta-shaped Billroth I (B-I) anastomosis following minimally invasive distal gastrectomy (DG) is a simple and highly reproducible gastroduodenostomy procedure. This study aimed to identify the technical pitfalls of this procedure and assess their influence on one-year outcomes.

METHODS

This was a retrospective study including patients who underwent delta-shaped B-I anastomosis following minimally invasive DG at our institution between 2008 and 2022. Delta-shaped B-I anastomosis was performed by adhering to five fundamental elements. Data were collected from our prospectively maintained database and analyzed retrospectively. Intra- and postoperative complications were reviewed, and video analysis was performed to identify technical errors associated with these complications. One-year outcomes, including nutritional status and endoscopic findings, were compared between patients with and without complications within 30 days after surgery.

RESULTS

A total of 749 patients were included in this study. A total of 36 operating surgeons were involved. Intraoperative anastomotic complications occurred in 0.8% of patients, mainly due to technical issues during linear stapling. Postoperative anastomosis-related complications occurred in 2.1% of patients, with anastomotic leakage, stricture, and delayed gastric emptying rates of 0.9%, 0.3%, and 0.9%, respectively. Most complications were managed conservatively or endoscopically. No late-onset strictures were observed at postoperative year 1, and no significant differences in nutritional and endoscopic findings were observed between patients with and without complications.

CONCLUSION

When performed according to five fundamental technical principles, intracorporeal delta-shaped B-I anastomosis following minimally invasive DG proved to be a safe, reproducible procedure associated with favorable one-year outcomes.