A novel clipping method for duodenal stump reinforcement in laparoscopic gastric cancer surgery: does it prevent leaks? Results from a multicenter study.

INTRODUCTION: Duodenal stump leakage (DSL) is a serious complication after laparoscopic gastrectomy due to gastric cancer (GC). It is associated with increased morbidity and mortality rates, prolonged hospital stay, and complex management. AIM: The aim of this study was to evaluate whether a novel, technically simple clipping technique could help reduce the rate of DSL. MATERIALS AND METHODS: This retrospective multicenter study included patients who underwent laparoscopic radical gastrectomy with D2 lymphadenectomy for gastric adenocarcinoma at 2 tertiary centers. The patients were categorized according to the use of duodenal stump clipping during the procedure. Demographic, clinical, intraoperative, and postoperative variables were compared. The risk factors for DSL were evaluated using univariate and multivariable analyses. RESULTS: A total of 381 patients at a median (interquartile range [IQR]) age of 63 (55-71) years were analyzed; 175 (45.9%) underwent duodenal stump clipping, and 248 (65.1%) were men. The incidence of DSL was lower in the clipping group than the nonclipping group (1.7% vs 5.8%; P = 0.04). The clipping cohort also demonstrated reduced median (IQR) hospital stay (7 [6-10] vs 10 [8-13] d; P <⁠0.001) and a lower 30-day major complication rate (9.1% vs 16%; P = 0.046). In the multivariable analysis, duodenal clipping was not significantly associated with DSL. CONCLUSIONS: Duodenal clipping is a simple and technically feasible method for reinforcing the duodenal stump during laparoscopic GC surgery.