A simple method for tension-free Billroth I anastomosis after gastrectomy for gastric cancer

Billroth I anastomosis (B-I), or gastroduodenostomy, is a popular reconstructive procedure performed after a distal gastrectomy for the treatment of gastric cancer. The advantages of B-I include simplicity, the maintenance of physiological food passage, and the retention of iron metabolism after distal gastrectomy (1,2). Because tension at the anastomotic site is a major cause of post-operative leaking, most of surgeons perform Kocher’s maneuver to decrease tension after B-I. However, sometimes Kocher’s maneuver alone does not adequately decrease the tension. Herein we introduce a new, simple technique to minimize tension after B-I for gastric cancer.