1. Laparoscopic Technique and Initial Experience with Knotless, Unidirectional Barbed Suture Closure for Staple-Conserving, Delta-Shaped Gastroduodenostomy after Distal Gastrectomy 
Sang-Woong Lee, MD, PhD, Eiji Nomura, MD, PhD, Takaya Tokuhara, MD, PhD, Masaru Kawai, MD, PhD, Nobuhisa Matsuhashi, MD, PhD, Kazutake Yokoyama, MD, Hiroya Fujioka, MD, Masako Hiramatsu, MD, PhD, Junji Okuda, MD, PhD, FACS, Kazuhisa Uchiyama, MD, PhD 
Journal of the American College of Surgeons 
Volume 213, Issue 6, Pages e39-e45 (December 2011)
DOI: /j.jamcollsurg
Copyright © 2011 American College of Surgeons Terms and Conditions

2. Figure 1
Thirty-centimeter 3-0 V-Loc 180 suture on a V-20 needle (26 mm tapered): (A) no barbs in the first 2 cm of the suture, allowing for readjustment of the throw without adverse effects, and a loop at the other end for passing the needle to secure the suture; (B) a close-up of unidirectional barbed suture; (C) micrograph of the laser-etched barbs.
Journal of the American College of Surgeons  , e39-e45DOI: ( /j.jamcollsurg )
Copyright © 2011 American College of Surgeons Terms and Conditions

3. Figure 2
Insertion of a cartridge fork into the gastrostomy along the posterior wall of the gastric stump.
Journal of the American College of Surgeons  , e39-e45DOI: ( /j.jamcollsurg )
Copyright © 2011 American College of Surgeons Terms and Conditions

4. Figure 3
Insertion of an anvil fork into duodenal stump, with each fork positioned to join the posterior walls together.
Journal of the American College of Surgeons  , e39-e45DOI: ( /j.jamcollsurg )
Copyright © 2011 American College of Surgeons Terms and Conditions

5. Figure 4
V-shaped stapler entry hole between the stomach and the duodenum.
Journal of the American College of Surgeons  , e39-e45DOI: ( /j.jamcollsurg )
Copyright © 2011 American College of Surgeons Terms and Conditions

6. Figure 5
Step 1 of the intracorporeal suture closure of the common enterotomy hole for the stapler showing the full-thickness inner layer closure using a knotless unidirectional barbed suture, starting from the corner of the great curvature.
Journal of the American College of Surgeons  , e39-e45DOI: ( /j.jamcollsurg )
Copyright © 2011 American College of Surgeons Terms and Conditions

7. Figure 6
Step 2 of the intracorporeal suture closure of the common enterotomy hole for the stapler showing the second seromuscular layer closure using the same suture, returning from the lesser curve.
Journal of the American College of Surgeons  , e39-e45DOI: ( /j.jamcollsurg )
Copyright © 2011 American College of Surgeons Terms and Conditions

8. Figure 7 Completed staple-conserving delta-shaped gastroduodenostomy.
Journal of the American College of Surgeons  , e39-e45DOI: ( /j.jamcollsurg )
Copyright © 2011 American College of Surgeons Terms and Conditions

9. Figure 8
Upper gastrointestinal contrast study showing patency and shape staple-conserving gastroduodenostomy.
Journal of the American College of Surgeons  , e39-e45DOI: ( /j.jamcollsurg )
Copyright © 2011 American College of Surgeons Terms and Conditions