Background: Totally laparoscopic distal gastrectomy (TLDG) is a minimally invasive method for gastric cancer. Intracorporeal reconstruction of the digestive tract with technically challenging is a critical step.
Objective: This study aimed to evaluate the feasibility and efficacy of a simplified method using a unidirectional barbed suture to create a continuous hand-sewn for gastrointestinal enterotomy closure and reinforcement of the duodenal stump (RDS) in our institutional experience.
Methods: From March 2019 to December 2019, 32 patients who underwent TLDG with a hand-sewn gastrojejunostomy (GJA), jejunojejunostomy (JJ) and reinforcement the duodenal stump (RDS) were enrolled in this study. After tumor resection, the technique with the knotless unidirectional barbed suture was used to close the common incision for the linear stapler during the intracorporeal reconstruction following the TLDG. Patient
characteristics, operative time, length of hospital stay, the time of the first flatus, and postoperative complications were evaluated.
Results: The reinforcement and closure method were successfully performed after TLDG in the 32 patients without re-exploration. No major adverse events occurred during or after the operation. The mean procedure time was (247.3 ± 44.2) min, while the common incision closure procedure took a mean of 9.5±1.6min, the Laparoscopic Reinforcement Suture (LRS) procedure took a mean of 5.7± 0.9min, the blood loss was (68.0 ± 48.3) ml. The mean number of LNs dissected was (31.5 ± 11.3), the mean time of the first flatus was (3.7±1.2) days, the postoperative bed activity time (1.7±0.3)days, and the mean postoperative hospital stay was(9.5±2.7)days. The complications rate was 6.3%, including one emptying dysfunction, and one local abscess near duodenal stumps.
Conclusions: The use of the unidirectional absorbable barbed suture for gastrojejunal/ jejunojejunal enterotomy closure and reinforcement of the duodenal stump is safe and effective in TLDG.