Gastric Cancer Surgery: Three Common Anastomosis Techniques

In the treatment of gastric cancer, surgical resection remains a primary option. With advancements in medical technology, procedures have evolved from traditional open surgery to minimally invasive techniques such as laparoscopic and robotic-assisted surgeries. Regardless of the approach, the type of anastomosis performed after gastric resection plays a crucial role in patient recovery and long-term outcomes. Below is an overview of three widely used anastomosis methods:

B1 Anastomosis – Gastroduodenostomy

This technique is commonly used in distal gastric cancer cases. After removing the affected portion of the stomach, the surgeon connects the remaining upper part of the stomach directly to the duodenum. This method preserves the natural digestive pathway and is often preferred when the tumor location allows for a straightforward connection.

B2 Anastomosis – Gastrojejunostomy with Duodenal Stump Closure

In situations where connecting the stomach to the duodenum is not feasible, the duodenum is sealed off at the top, and the remaining stomach is connected to the jejunum (a part of the small intestine). This method helps avoid complications related to duodenal stump leakage. Additionally, a side-to-side jejunal anastomosis may be performed to prevent bile reflux and reduce postoperative discomfort.

Roux-en-Y Anastomosis – Advanced Reconstruction Technique

After removing the distal stomach, the surgeon cuts the jejunum approximately 15–20 cm beyond the Treitz ligament. The upper section of the jejunum is then connected to the remaining stomach, while the lower segment is reconnected to the upper jejunum around 30–60 cm away. This method is particularly effective in preventing postoperative gastroesophageal reflux disease (GERD), especially after total gastrectomy. It has become a gold standard in many complex gastric cancer surgeries due to its functional benefits and reduced risk of long-term complications.