Billroth-I reconstruction using an overlap method in totally laparoscopic distal gastrectomy

propensity score matched cohort study of short- and long-term outcomes compared with Roux-en-Y reconstruction

Yusuke Watanabe, Masato Watanabe, Nobuhiro Suehara, Michiyo Saimura, yusuke mizuuchi, Kazuyoshi Nishihara, Toshimitsu Iwashita, Toru Nakano

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Background: Delta-shaped anastomosis is an established procedure for intracorporeal Billroth-I reconstruction (B-I). However, this procedure has several technical and economic problems. The aim of the current study was to present the technique of B-I using an overlap method (overlap B-I), which is a side-to-side intracorporeal gastroduodenostomy in laparoscopic distal gastrectomy (LDG), and to evaluate the short- and long-term outcomes of this overlap B-I procedure. Methods: We retrospectively reviewed the medical records of 533 patients who underwent LDG with overlap B-I (n = 247) or Roux-en-Y reconstruction (R-Y) (n = 286). Patients with overlap B-I were propensity score matched to patients with R-Y in a 1:1 ratio. Short- and long-term outcomes of the two procedures were compared after matching. Results: In the total cohort, anastomosis-related complications occurred in 2.4% of patients with overlap B-I, and 3.2% of those with R-Y (P = 0.794). Morbidity rate, including anastomosis-related complications, and postoperative course were comparable after overlap B-I performed by qualified versus general surgeons. Of 247 patients with overlap B-I, 169 could be matched. After matching, morbidity rate and postoperative course were comparable between the two procedures. Median operation time was significantly shorter for overlap B-I (205 min) than R-Y (252 min; P < 0.001). The incidence of readmission due to gastrointestinal complications was significantly lesser after overlap B-I (2.4%) compared with R-Y (21.9%; P < 0.001). The main causes of readmission after R-Y were bowel obstruction (7.3%) and gallstones (8.0%). Regarding the development of common bile duct (CBD) stones, 11 patients (3.8%) who underwent R-Y were readmitted due to CBD stones, whereas no patients who underwent B-I developed CBD stones. Conclusions: Overlap B-I is feasible and safe, even when performed by general surgeons. B-I was superior to R-Y concerning operation time and readmission due to gastrointestinal complications.

Original languageEnglish
JournalSurgical endoscopy
DOIs
Publication statusPublished - Jan 1 2019

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Gastroenterostomy
Propensity Score
Gastrectomy
Cohort Studies
Common Bile Duct
Morbidity
Gallstones

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Billroth-I reconstruction using an overlap method in totally laparoscopic distal gastrectomy : propensity score matched cohort study of short- and long-term outcomes compared with Roux-en-Y reconstruction. / Watanabe, Yusuke; Watanabe, Masato; Suehara, Nobuhiro; Saimura, Michiyo; mizuuchi, yusuke; Nishihara, Kazuyoshi; Iwashita, Toshimitsu; Nakano, Toru.

In: Surgical endoscopy, 01.01.2019.

Research output: Contribution to journalReview article

@article{9be860108e094a179e777967d308c57d,
title = "Billroth-I reconstruction using an overlap method in totally laparoscopic distal gastrectomy: propensity score matched cohort study of short- and long-term outcomes compared with Roux-en-Y reconstruction",
abstract = "Background: Delta-shaped anastomosis is an established procedure for intracorporeal Billroth-I reconstruction (B-I). However, this procedure has several technical and economic problems. The aim of the current study was to present the technique of B-I using an overlap method (overlap B-I), which is a side-to-side intracorporeal gastroduodenostomy in laparoscopic distal gastrectomy (LDG), and to evaluate the short- and long-term outcomes of this overlap B-I procedure. Methods: We retrospectively reviewed the medical records of 533 patients who underwent LDG with overlap B-I (n = 247) or Roux-en-Y reconstruction (R-Y) (n = 286). Patients with overlap B-I were propensity score matched to patients with R-Y in a 1:1 ratio. Short- and long-term outcomes of the two procedures were compared after matching. Results: In the total cohort, anastomosis-related complications occurred in 2.4{\%} of patients with overlap B-I, and 3.2{\%} of those with R-Y (P = 0.794). Morbidity rate, including anastomosis-related complications, and postoperative course were comparable after overlap B-I performed by qualified versus general surgeons. Of 247 patients with overlap B-I, 169 could be matched. After matching, morbidity rate and postoperative course were comparable between the two procedures. Median operation time was significantly shorter for overlap B-I (205 min) than R-Y (252 min; P < 0.001). The incidence of readmission due to gastrointestinal complications was significantly lesser after overlap B-I (2.4{\%}) compared with R-Y (21.9{\%}; P < 0.001). The main causes of readmission after R-Y were bowel obstruction (7.3{\%}) and gallstones (8.0{\%}). Regarding the development of common bile duct (CBD) stones, 11 patients (3.8{\%}) who underwent R-Y were readmitted due to CBD stones, whereas no patients who underwent B-I developed CBD stones. Conclusions: Overlap B-I is feasible and safe, even when performed by general surgeons. B-I was superior to R-Y concerning operation time and readmission due to gastrointestinal complications.",
author = "Yusuke Watanabe and Masato Watanabe and Nobuhiro Suehara and Michiyo Saimura and yusuke mizuuchi and Kazuyoshi Nishihara and Toshimitsu Iwashita and Toru Nakano",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00464-019-06688-z",
language = "English",
journal = "Surgical Endoscopy",
issn = "0930-2794",
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TY - JOUR

T1 - Billroth-I reconstruction using an overlap method in totally laparoscopic distal gastrectomy

T2 - propensity score matched cohort study of short- and long-term outcomes compared with Roux-en-Y reconstruction

AU - Watanabe, Yusuke

AU - Watanabe, Masato

AU - Suehara, Nobuhiro

AU - Saimura, Michiyo

AU - mizuuchi, yusuke

AU - Nishihara, Kazuyoshi

AU - Iwashita, Toshimitsu

AU - Nakano, Toru

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Delta-shaped anastomosis is an established procedure for intracorporeal Billroth-I reconstruction (B-I). However, this procedure has several technical and economic problems. The aim of the current study was to present the technique of B-I using an overlap method (overlap B-I), which is a side-to-side intracorporeal gastroduodenostomy in laparoscopic distal gastrectomy (LDG), and to evaluate the short- and long-term outcomes of this overlap B-I procedure. Methods: We retrospectively reviewed the medical records of 533 patients who underwent LDG with overlap B-I (n = 247) or Roux-en-Y reconstruction (R-Y) (n = 286). Patients with overlap B-I were propensity score matched to patients with R-Y in a 1:1 ratio. Short- and long-term outcomes of the two procedures were compared after matching. Results: In the total cohort, anastomosis-related complications occurred in 2.4% of patients with overlap B-I, and 3.2% of those with R-Y (P = 0.794). Morbidity rate, including anastomosis-related complications, and postoperative course were comparable after overlap B-I performed by qualified versus general surgeons. Of 247 patients with overlap B-I, 169 could be matched. After matching, morbidity rate and postoperative course were comparable between the two procedures. Median operation time was significantly shorter for overlap B-I (205 min) than R-Y (252 min; P < 0.001). The incidence of readmission due to gastrointestinal complications was significantly lesser after overlap B-I (2.4%) compared with R-Y (21.9%; P < 0.001). The main causes of readmission after R-Y were bowel obstruction (7.3%) and gallstones (8.0%). Regarding the development of common bile duct (CBD) stones, 11 patients (3.8%) who underwent R-Y were readmitted due to CBD stones, whereas no patients who underwent B-I developed CBD stones. Conclusions: Overlap B-I is feasible and safe, even when performed by general surgeons. B-I was superior to R-Y concerning operation time and readmission due to gastrointestinal complications.

AB - Background: Delta-shaped anastomosis is an established procedure for intracorporeal Billroth-I reconstruction (B-I). However, this procedure has several technical and economic problems. The aim of the current study was to present the technique of B-I using an overlap method (overlap B-I), which is a side-to-side intracorporeal gastroduodenostomy in laparoscopic distal gastrectomy (LDG), and to evaluate the short- and long-term outcomes of this overlap B-I procedure. Methods: We retrospectively reviewed the medical records of 533 patients who underwent LDG with overlap B-I (n = 247) or Roux-en-Y reconstruction (R-Y) (n = 286). Patients with overlap B-I were propensity score matched to patients with R-Y in a 1:1 ratio. Short- and long-term outcomes of the two procedures were compared after matching. Results: In the total cohort, anastomosis-related complications occurred in 2.4% of patients with overlap B-I, and 3.2% of those with R-Y (P = 0.794). Morbidity rate, including anastomosis-related complications, and postoperative course were comparable after overlap B-I performed by qualified versus general surgeons. Of 247 patients with overlap B-I, 169 could be matched. After matching, morbidity rate and postoperative course were comparable between the two procedures. Median operation time was significantly shorter for overlap B-I (205 min) than R-Y (252 min; P < 0.001). The incidence of readmission due to gastrointestinal complications was significantly lesser after overlap B-I (2.4%) compared with R-Y (21.9%; P < 0.001). The main causes of readmission after R-Y were bowel obstruction (7.3%) and gallstones (8.0%). Regarding the development of common bile duct (CBD) stones, 11 patients (3.8%) who underwent R-Y were readmitted due to CBD stones, whereas no patients who underwent B-I developed CBD stones. Conclusions: Overlap B-I is feasible and safe, even when performed by general surgeons. B-I was superior to R-Y concerning operation time and readmission due to gastrointestinal complications.

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U2 - 10.1007/s00464-019-06688-z

DO - 10.1007/s00464-019-06688-z

M3 - Review article

JO - Surgical Endoscopy

JF - Surgical Endoscopy

SN - 0930-2794

ER -