fig2

Figure 2. Intracorporeal hemi-hand-sewn Billroth-I anastomosis. After having confirmed approximately 5 cm away from the edge of the greater curvature for anastomosis, the remaining staple line is reinforced by continuous suture (A); sero-muscular stay sutures are placed between the remnant stomach and the duodenum (B); the anterior wall of the remnant stomach is incised (C); subsequently, the anterior wall of the duodenum is also incised (D); the posterior wall of the remnant stomach and the duodenum is brought together with the Echelon 60-3.5 from the umbilical port: laparoscopic view from the stomach side (E) and from the duodenal side (F); full thickness of posterior wall anastomosis is completed (G); then a whole-layer approximation is accomplished by continuous suture with an absorbable thread (H); finally, an anterior sero-muscular suture is completed by interrupted sutures (I)