Sutureless Gastroduodenostomy after Radical Subtotal Gastrectomy

ABSTRACT

PURPOSE: A gastroduodenostomy (Billroth I) is the most physiologic reconstructive method available today, it has recently been used more frequently subsequent to radical subtotal gastrectomies for the treatment of gastric cancers. However, it is inevitable that gastroduodenostomies involving sutures or staples may have complications such as ulcers, bleeding, or constriction caused by remaining foreign materials. We analyzed the results of sutureless gastroduodeno stomies using biofragmentable anastomosis rings (BAR) with regard to safety, usefulness and profits. METHODS: Sutureless gastroduodenostomies using BAR (Valtrac, Davis & Geck Wayne, NJ) composed of polyglycolic acid and Barium for x-ray visualization, performed after radical subtotal gastrectomies in 17 gastric cancer patients in the period from 1999 to 2001. RESULTS: Five patients had early cancers and 12 had advanced cancers. The mean size of the tumor masses was 5.0 X 3.7 cm, and the mean lengths of the proximal and distal resection margins from the tumors were 7.6 cm and 3.0 cm respectively. The lengths of lesser curvature and greater curvature of the resection specimens were 10.6 cm and 20.5 cm respectively. Fourteen tumors were located in the antrum and the other 3 were located in the body. The mean operating time was 164.4+/-35.2 min., and the mean hospital stay was 14.1+/-3.1 days. Sips of water could be started 4.4+/-0.5 days after the operation. In all patients, the sutureless gastroduodenostomy site appeared watertight and maintained its initial burst strength, which was verified using gastrografin x-ray visualization performed 1 week after the operation. There were no anastomosis related complications in any of the patients; except for two mild satiety, which were treated quickly by the patients themselves. The BAR began to fragment 3 weeks after the operation, and disappeared completely within 4 weeks. The diameters of the anastomosis sites were large enough to pass foods without constriction and no other secondary changes developed in the Barium x-ray visualization or endoscopic examination, which was performed 1 month after the operation. CONCLUSION: A sutureless gastroduodenostomy using BAR is a safe, easy, and efficient reconstructive method to be used subsequent to a radical subtotal gastrectomy for gastric cancers.