Intracorporeal circular-stapled gastroduodenostomy for billroth I reconstruction in total laparoscopic distal gastrectomy

Objectives While laparoscopic distal gastrectomy (LDG) has gained acceptance for early gastric cancer, challenges persist in intracorporeal circular-stapled gastroduodenostomy during totally laparoscopic distal gastrectomy (TLDG). This study introduces a novel technique using a laparoscopic purse-string suture clamp (Lap-PSC) and multifunctional sealing cap (MSC) to simplify Billroth I circular-stapled anastomosis. Methods A single-center retrospective analysis was conducted on 47 gastric cancer patients undergoing TLDG with Lap-PSC and MSC between September 2022 and June 2024. Surgical procedures involved D2 lymph node dissection, a 5 cm upper abdominal incision for specimen extraction, and intracorporeal circular-stapled anastomosis using Lap-PSC for duodenal purse-string suturing and MSC for pneumoperitoneum maintenance. Postoperative outcomes, complications, and anastomotic integrity were evaluated. Results All 47 patients underwent successful TLDG with negative resection margins. Mean operative time was 148.3 ± 41.4 min. One patient (2.1%) experienced postoperative gastroparesis, and one patient (2.1%) experienced postoperative pneumonia. No anastomotic leaks, strictures, or perioperative deaths occurred. Median follow-up was 21.4 months (range: 13–34), with no recurrence or anastomosis-related complications. Conclusion TLDG with Circular-Stapled Gastroduodenostomy for Billroth I anastomosis demonstrates technical feasibility and safety, combining the precision of open surgery with laparoscopic minimally invasive benefits. The technique simplifies intracorporeal circular-stapled anastomosis, avoids excessive tension, and may reduce ischemic risks associated with linear stapler methods.