Delta Anastomosis in Billroth I Reconstruction
The correct answer is B: A delta anastomosis refers to a triangular stapled anastomosis between the gastric remnant and duodenum in Billroth I reconstruction.
Technical Definition and Characteristics
The delta-shaped anastomosis is an intracorporeal Billroth I reconstruction technique that creates a triangular-shaped gastroduodenostomy using only endoscopic linear staplers 1, 2. This technique is specifically designed for laparoscopic and robotic distal gastrectomy procedures 1, 3.
Key Technical Features
The procedure involves the following steps:
- Small incisions are made on the greater curvature of the remnant stomach and the posterior side (or anterior wall) of the duodenum 2, 3
- The stapler forks are inserted through these incisions and the posterior walls of the gastric remnant and duodenum are approximated 2
- A functional end-to-end anastomosis is created by firing the stapler, forming the characteristic triangular or delta shape 1, 2
- The common entry hole is closed with another stapler firing, completing the anastomosis 2, 4
Clinical Performance
The delta anastomosis demonstrates excellent safety and feasibility profiles:
- Mean anastomosis time ranges from 13.9 to 16.5 minutes in experienced hands 1, 2
- No anastomosis-related complications (leakage, stricture, or hemorrhage) were reported in multiple case series 2
- Long-term functional outcomes are comparable to conventional Billroth I techniques, with similar nutritional indices and 5-year survival rates 4
- Endoscopic evaluation shows relatively better gastritis findings despite slightly worse bile reflux compared to conventional techniques 4
Why Other Options Are Incorrect
Option A is incorrect because side-to-side anastomosis between gastric remnant and jejunum describes a Billroth II reconstruction, not Billroth I 5. The delta anastomosis specifically connects the stomach to the duodenum, which is the defining feature of Billroth I 1, 2.
Option C is incorrect because while hand-sewn techniques exist for Billroth I, the delta anastomosis is specifically a stapled technique using endoscopic linear staplers 1, 2, 4. Additionally, connecting to the jejunum would make this a Billroth II, not Billroth I.
Option D is incorrect because omega-shaped anastomosis between gastric remnant and esophagus describes a reconstruction after total gastrectomy or proximal gastrectomy, not a Billroth I procedure which preserves the gastric remnant and reconnects to the duodenum 6.
Clinical Context
The delta anastomosis has become increasingly adopted by gastrointestinal surgeons as a preferred method for intracorporeal Billroth I reconstruction after laparoscopic distal gastrectomy 2. It offers advantages of being technically safe, feasible, and requiring fewer stapler cartridges compared to some alternative techniques 4, 7.