A Simple and Safe Method for Billroth I Reconstruction in Single-Incision Laparoscopic Gastrectomy Using a Novel Intracorporeal Triangular Anastomotic Technique

The intracorporeal anastomosis is one of the most difficult procedures in single-incision laparoscopic gastrectomy for gastric cancer. We describe a simple technique for intracorporeal triangular Billroth I anastomosis in transumbilical single-port surgery. After adequate lymphadenectomy, the stomach and duodenum were staple-transected. Small incisions were made to the remnant stomach and the duodenum. The anvil of a linear stapler and a staple compartment were inserted through the holes, and then both ends were stitched up together by stapler. This staple line would be the bottom of the triangular anastomosis. The second and third lines were created by closure of the common hole and with simultaneous removal of three staple lines (stumps of the stomach and duodenum and the ventral side of the first anastomosis) using two linear staplers, respectively, completing the triangular anastomosis. We performed this technique in 45 patients between March and December 2011. All procedures were completed in single-port approaches. There were no postoperative anastomotic complications such as anastomotic leak and stricture. The median postoperative hospital stay was 7 days. Our technique for intracorporeal Billroth I reconstruction is safe and feasible. This technique could be a useful surgical option in all laparoscopic reconstructive procedures using linear stapling devices.