Effects of anastomotic techniques in laparoscopic distal gastrectomy with Billroth I method on remnant stomach motor functions and postoperative quality of life

Abstract

Laparoscopic distal gastrectomy with Billroth I reconstruction (LDGBI) is a standard procedure for early-stage gastric cancer. Although both Delta-shaped (Delta) and circular stapler (CS) techniques are commonly used for anastomosis, their long-term effects on remnant gastric motility and postoperative quality of life (QOL) remain insufficiently defined. This retrospective study analyzed 43 patients who underwent LDGBI at least one year prior, divided into CS (n=22) and Delta (n=21) groups. Gastric emptying was evaluated using the ¹³C-acetate breath test, focusing on residual reservoir capacity (RR5) and half-emptying time (T1/2). Postgastrectomy symptoms and living status were assessed via structured questionnaires. The Delta group demonstrated significantly lower RR5 (40.5% vs. 56.1%, P=0.033) and shorter T1/2 (4.8 vs. 8.5 min, P=0.033), indicating diminished reservoir function and accelerated gastric emptying. These alterations correlated with a higher incidence of early dumping abdominal symptoms (66.7% vs. 27.3%, P=0.015), as well as trends toward increased early dumping general symptoms and greater body weight loss. The Delta method is associated with enhanced gastric emptying and more frequent postgastrectomy symptoms, likely due to a wider anastomotic stoma. Tailoring the stoma size or selecting alternative reconstruction methods based on remnant gastric volume may help mitigate adverse outcomes and improve patients’ quality of life following LDGBI.