Usefulness of Bidirectional Barbed Sutures for Temporary Closure of Entry Hole for Delta-Shaped Anastomosis in Minimally Invasive Gastrectomy.

Introduction: Laparoscopic and robotic gastrectomies have become standard procedures for the treatment of gastric cancer. Among the reconstruction methods used following distal gastrectomy, the Billroth-I technique is often preferred owing to its low complication rates. Delta-shaped anastomosis, a method that eliminates the need for a mini-laparotomy, represents a significant advancement in minimally invasive surgeries. In this report, we aim to present a novel technique using bidirectional barbed sutures for temporary closure of the entry hole during delta-shaped anastomosis in laparoscopic and robotic gastrectomies.

Materials And Surgical Technique: The entry hole was closed using a bidirectional barbed suture, starting centrally to prevent overlapping of the gastric and duodenal staple lines. The suture length was meticulously adjusted to align with the stapler dimensions. All the procedures were successfully completed without any complications in both laparoscopic and robotic gastrectomies. Bidirectional barbed sutures enabled precise tissue alignment and prevented slippage, thereby facilitating secure, full-thickness closure of the entry hole while minimizing the risk of incomplete stapler firing.

Conclusion: Bidirectional barbed sutures offer a safe and feasible alternative option for the temporary closure of the entry hole during a stapled anastomotic technique in robotic and laparoscopic gastrectomies.