Enterotomy closure after minimally invasive distal gastrectomy with intracorporeal anastomosis: a multicentric study

Introduction: Despite progressive improvements in technical skills and instruments have facilitate surgeons to perform intracorporeal gastro-jejunal and jejuno-jejunal anastomoses, one of the big challenging task is handsewn knot tying. We analysed the better way to fashion an handsewn intracorporeal enterotomy closure after a stapled anastomosis. Methods: All 579 consecutive patients from January 2009 to December 2019 who underwent minimally invasive partial gastrectomy for gastric cancer at thirteen high-volume institutions were retrospectively analysed. Different ways to fashion intracorporeal anastomoses were investigated: robotic vs. laparoscopic approach; laparoscopic HD vs. 3D vs. 4K technology; single layer vs. double layer enterotomies. Additionally, double layer enterotomies were analysed layer by layer, comparing running vs. interrupted suture; presence vs. absence of deep corner suture and type of suture thread (barbed, braided, non-braided suture). Results: Significant lower rates of bleeding (p = 0,011) and leakage (p = 0,048) from gastro-jejunal anastomosis were recorded in the double-layer group. Comparing barbed to braided and non-braided suture threads, the first was significantly associated to reduced intraluminal bleeding and leakage rates both in the first (p = 0,042 and p = 0,010) and second layer (p = 0,002 and p = 0,029). Conclusions: Our study found that double-layer sutures using barbed suture thread both in first and second layer to fashion enterotomy closure results in lower intraluminal bleeding and anastomotic leak rates.