Billroth I anastomosis using a circular stapler for corrosive gastric stricture - A novel technique

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Abstract

INTRODUCTION: Resection and hand-sewn Billroth I reconstruction is the commonly carried out procedure for type I gastric strictures. The use of staplers for Billroth I anastomosis is limited. Here we describe a unique technique of Billroth I anastomosis using a circular stapler without a gastrotomy in a case of corrosive gastric stricture. CASE SUMMARY AND TECHNIQUE: A fourteen-year-old girl with Type I gastric stricture underwent resection of the pre-pyloric stricture and Billroth I reconstruction, for which the shaft of the circular stapler was inserted through the open end of the stomach and a side-to-end anastomosis of the posterior wall of the stomach with the end of the duodenum was carried out. The distal cut open end of the stomach was closed with a linear cutter. The patient made an uneventful recovery. CONCLUSION: A circular stapler can be used by this technique for Billroth I anastomosis for a pre-pyloric corrosive stricture without a need for additional gastrotomy for introducing the stapler.

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New techniques of gastrointestinal anastomoses with the EEA stapler.

Stephanie Nance (1979)

A new instrument for accomplishing inverted stapled anastomoses in the gastrointestinal tract is described. Side-to-side, end-to-side and end-to-end anastomoses can be performed. Techniques developed for utilization of the instrument in virtually all gastrointestinal anastomoses are described. In most instances a proximal or distal enterotomy is required. Experience with 57 anastomoses in 42 patients is reported. One leak occurred; no other complications not recognized intraoperatively were observed. Anastomoses completed included gastroduodenostomy, gastrojejunostomy, cholecystojejunostomy, colocolostomy and ileocolostomy. Hazards and complications associated with the use of the instrument are described. It should be used only after the surgeon has acquired the skills to operate the instrument properly. The instrument saves time, creates better anastomoses than can be obtained by hand sewing and is extremely versatile. It may permit safer anastomoses in adverse conditions, such as in obstruction and peritonitis. The instrument opens new horizons in gastrointestinal surgery.