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Zhang et al. Mini-invasive Surg 2019;3:2  I  http://dx.doi.org/10.20517/2574-1225.2018.64                                          Page 5 of 7


               Table 1. Summary of different methods applied in intracorporeal Billroth-I reconstruction
                Year     Author  No.   Age        Method  Anastomotic   Operative   Blood loss Postoperative   Anastomosis-
                                                      time (min)  time (min)        stay (d)     related
                                                                                               complations
                                            Hand-sewn anastomosis in intracorporeal B-I
                                            reconstruction
                2003  Takiguchi et al. [6]  1  50  Hand-sewn  90  420     NS        7        0
                2012  Matsuo et al. [7]  18  NS  Hand-sewn  64.6  NS      53.1 ± 91   21.7   0
                                            Circular stapler used in intracorporeal B-I
                                            reconstruction
                1995  Uyama et al. [8]  1  56  CS    NS        318        NS        14       0
                2012  Kim et al. [13]  23  60.3 ± 11.3 CS  43.3 ± 15.4  209.7 ± 49.9   72.6 ± 47.9   7.7 ± 2.3   0
                2012  Omori et al. [15]  20  NS  CS  NS        279        NS        9        0
                                            Linear stapler intracorporeal B-I reconstruction
                2011  Kanaya et al. [17]  100 65.5 ± 9.3  DA  13.0 ± 3.9  239.2 ± 53.2   92.6 ± 89.7   16.7 ± 13.8  1 (anastomotic leak)
                2014  Okabe et al. [20]  185  NS  DA  NS       283        NS        NS       5 (anastomotic leak)
                                                                                             3 (delayed gastric
                                                                                             emptying)
                2011  Noshiro et al. [19]  71  70 ± 10  DA  NS  260 ± 56  63 ± 79   NS       6 (anastomotic leak)
                2014  Huang et al. [22]  102  60 ± 12  Modified DA  12.2 ± 4.2  150.6 ± 30.2  48.2 ± 33.2   12.0 ± 6.5  2 (anastomotic leak)
                2008  Tanimura et al. [24]  196  NS  TST  28 ± 4  249 ± 38  NS      NS       1 (anastomotic leak)
                2013  Ikeda et al. [25]  9  59.3  BBT  34 ± 7  255 ± 13   50 ± 66   14.2 ± 2.3  0
                2016  Byun et al. [26]  190  57.2 ± 12.5 LSGD  NS  147.9 ± 49.4   97.3 ± 95.7   6.8 ± 3.1   2 (anastomotic
                                                                                             stenosis)
                2018  Fukunaga et al. [27]  160  69.5 ± 10   ART  NS  227 ± 75  47.3 ± 50   12 ± 5   0

               CS: Circular stapler; DA: delta-shaped anastomosis; TST: triangulating stapling technique; BBT: book-binding technique; LGSD: linear-
               shaped gastroduodenostomy; ART: augmented rectangle technique; NS: not stated

               end of the duodenal stump was rotated externally by 90°. After the initial suturing between the remnant
               stomach and the duodenum, the two sides (posterior wall and cranial wall), the posterior wall and caudal
               wall, form a V-shape. A 30 mm linear stapler was applied to close the insertion holes up to the closest
               side of the duodenal resection margin. After gastric and duodenal resection margins were ensured to be
               close together, the 60 mm laparoscopic linear stapler was used to transect the duodenal resection margin
               to create the margin. After the above steps, all the previous linear staplers were removed from duodenal
               resection margin.


               Thanks to the elimination of the stay sutures in the anastomosis site, the risk of leakage of the intestinal
               contents into the peritoneal cavity can be reduced with a result of reduced incidence of peritoneal
               abscess [28,29] . Removing the staple line of the duodenal stump without creating a T-shaped anastomotic
               region can avoid postoperative stenosis. The ART can create larger 4-sided anastomosis diameters than
               3-sided ones, without worrying about whether the width of the opening will be reduced by the final stapling.



               APPLICATION OF BARBED SUTURE IN INTRACORPOREAL ANASTOMOSES
               Intracorporeal suturing and knot typing in some B-I anastomosis were time-consuming and tedious and
               especially these procedures were the last steps to do in LDG. But various devices have been developed
               to simplify the placement of intracorporeal sutures, and barbed suture is one such device. Using the
               barber suture could reduce the number of knot typing, the suturing efficiency and reduce the cost of
                                                    [30]
                                                               [30]
               intracorporeal reconstruction with staplers . Lee et al.  used barber sutures to close entry hole in 354
               patients instead of staplers with a result of minimizing the suturing time. There were no patients who
               needed to be converted to usual sutures or mechanical closure with staplers and only one patient presented
               with postoperative anastomotic bleeding.



               CONCLUSION
               Several reconstruction techniques are possible after TLDG [Table 1]. The best reconstruction is the one,
               that simplifies the technique, maintains satisfactory nutritional status and quality of life while keeping
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