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Ohmura et al. Mini-invasive Surg 2019;3:4 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.69

Original Article Open Access

Intracorporeal hemi-hand-sewn technique for
Billroth-I gastroduodenostomy after laparoscopic
distal gastrectomy: comparative analysis with
laparoscopy-assisted distal gastrectomy

Yasushi Ohmura , Hiromitsu Suzuki , Kazutoshi Kotani , Atsushi Teramoto 2,3
1,2
2,3
2,4
1 Department of Cancer Treatment Support Center, Okayama City Hospital, Okayama 700-8557, Japan.
2 Department of Surgery, Okayama City Hospital, Okayama 700-8557, Japan.
3 Department of Surgery, Yakage Hospital, Okayama 714-1201, Japan.
4 Department of Surgery, Kasaoka Daiichi Hospital, Okayama 714-0043, Japan.
Correspondence to: Dr. Yasushi Ohmura, Department of Cancer Treatment Support Center, Okayama City Hospital. 1-20-3
Kitanagase-omotemachi, Kita-ku, Okayama 700-8557, Japan. E-mail: yohmura826@yahoo.co.jp

How to cite this article: Ohmura Y, Suzuki H, Kotani K, Teramoto A. Intracorporeal hemi-hand-sewn technique for Billroth-I
gastroduodenostomy after laparoscopic distal gastrectomy: comparative analysis with laparoscopy-assisted distal gastrectomy.
Mini-invasive Surg 2019;3:4. http://dx.doi.org/10.20517/2574-1225.2018.69
Received: 30 Nov 2018 First Decision: 30 Nov 2018 Revised: 30 Jan 2019 Accepted: 1 Feb 2019 Published: 27 Feb 2019

Science Editor: Tetsu Fukunaga Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu

Abstract
Aim: The purpose of this study was to evaluate the clinical feasibility and efficacy of the intracorporeal hemi-hand-sewn
(IC-HHS) technique for Billroth-I gastroduodenostomy in comparison with extracorporeal total hand-sewn (EC-THS)
anastomosis. We also examined the size of resected specimens in each procedure.

Methods: The number of enrolled cases of EC-THS and IC-HHS anastomosis groups were 85 and 110 cases, respectively.
Perioperative data and the measured sizes of resected specimens were analyzed.

Results: Operation time in the IC-HHS group was significantly longer than the EC-THS group (234.8 min vs. 275.0 min,
P < 0.01), whereas intraoperative blood loss was less in the IC-HHS group (48.4 mL vs. 25.4 mL, P = 0.03). There were
no procedure-related complications in the IC-HHS group. The greater curvature of the EC-THS group was significantly
shorter than the IC-HHS group (214.6 mm vs. 228.7 mm, P < 0.01). There was no correlation between body mass index
(BMI) and the length of the greater curvature in the IC-HHS group (r = 0.07, P = 0.47), but in the EC-THS group, the
length of the greater curvature tends to shorten as BMI increases (r = -0.45, P < 0.01).

Conclusion: IC-HHS technique for Billroth-I gastroduodenostomy revealed feasible with acceptable operation time and
postoperative outcome. Another advantage of total laparoscopic distal gastrectomy that intracorporeal transection can
facilitate is to ensure an adequate proximal margin, especially in obese middle gastric cancer patients.

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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and indicate if changes were made.

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