Duodenal Stump Reinforcement with Purse-string Suture in Distal Gastrectomy under Laparoscope Combined with Uncut Roux-en-Y Reconstruction in Patients with Gastric Cancer

Abstract Background: This study aimed to compare patient outcomes after laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction for gastric cancer between a group who underwent a duodenal stump reinforcement procedure and those who did not.Methods: Data from 233 patients with gastric cancer (GC) undergoing distal gastrectomy under laparoscope combined with uncut Roux-en-Y reconstruction were retrospectively investigated. Patients were divided into two groups. The non-reinforcement group (NR) underwent surgery from June 2014 to March 2015 with no reinforcement of the duodenal stump (n=54) and the reinforcement group (R) underwent surgery from April 2015 to June 2018 with reinforcement of the duodenal stump (n=179). In group R, the duodenum was divided using an endoscope-assisted linear stapler, which was reinforced by a purse-string suture along the duodenal staple line. Results: Duodenal stump leakage was observed in 2 patients from group NR (3.7%), while no duodenal stump leakage or fistula was detected in group R. In addition, no significant difference was observed in the patient characteristics between group NR and R.Conclusions: The incidence of duodenal stump leakage can be reduced by reinforcement with a purse-string suture.