Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
Langenbecks Arch Surg. 2022 Nov;407(7):3147-3152. doi: 10.1007/s00423-022-02669-4. Epub 2022 Sep 14.
Laparoscopic Billroth-I gastroduodenostomy using a delta-shaped anastomosis is safe and feasible. However, it is often difficult to perform in patients who have a short posterior wall of the duodenum. Thus, we have developed a new method named duodenal overlap functional anastomosis with linear stapler (DOLFIN). We hereby report the technical details of the new method and our preliminary experience performing it.
After the completion of lymphadenectomy, the duodenum was transected craniocaudally with an endoscopic linear stapler. The hepatoduodenal mesentery was dissected approximately 4 cm along the duodenal bulb, and the anastomosis between the posterior wall of the stomach and the lesser curvature of the duodenum was created. The common entry hole was then transected using an endoscopic linear stapler, and the anastomosis was finally completed.
There were 36 patients with gastric cancer who underwent laparoscopic distal gastrectomy (LDG) or robotic distal gastrectomy (RDG) with B-I reconstruction using DOLFIN. There were no postoperative complications classified as C-D grade 3 or more and complications related to anastomosis, such as anastomotic leak or stenosis.
Our DOLFIN gastroduodenostomy can be performed safely. In addition, it results in good postoperative outcomes. A long-term comparative study is required to further evaluate the clinical usefulness of this method.
腹腔镜 Billroth-I 式胃十二指肠吻合术采用 delta 吻合是安全可行的。然而，对于十二指肠后壁较短的患者，往往难以进行。因此，我们开发了一种名为使用线性吻合器的十二指肠重叠功能性吻合术（DOLFIN）的新方法。我们在此报告该新方法的技术细节及其初步应用经验。
完成淋巴结清扫后，用内镜直线切割吻合器纵向切割十二指肠。沿十二指肠球部切开肝十二指肠系膜约 4cm，完成胃后壁与十二指肠小弯侧的吻合。然后用内镜直线切割吻合器横断共同入口，最后完成吻合。
36 例胃癌患者接受了腹腔镜下远端胃切除术（LDG）或机器人辅助远端胃切除术（RDG），并使用 DOLFIN 行 Billroth-I 式重建。无术后并发症 C-D 分级 3 级或更高级别，也无吻合相关并发症，如吻合口漏或狭窄。
我们的 DOLFIN 式胃十二指肠吻合术是安全的，并且术后效果良好。需要进行长期的对照研究，以进一步评估该方法的临床应用价值。
