Handover method: Simple, classic and harmonized intracorporeal closure of stapled duodenal stump during laparoscopic gastrectomy

Laparoscopy‐assisted gastrectomy (LAG) has experienced a booming development over the last two decades. Owing to technical advances and the availability of innovative surgical equipment, totally laparoscopic gastrectomy (TLG) has recently become an unstoppable trend and enjoys huge population in laparoscopic gastrectomy (LG). However, compared with open gastrectomy (OG), the laparoscopic approach could increase the risk of duodenal stump leakage (DSL) development, which is a known serious postoperative complication of LG. Studies have indicated that the incidence of DSL after LG performed for malignancy ranges from 0% to 18.3%. Moreover, a multicenter study has reported a significantly high DSL‐induced complication rate of 75% that resulted in a total mortality rate of 16%. DSL, the life‐ threatening postoperative complication, could be attributed to several factors including inadequate duodenal stump closure, impaired blood supply, local hematoma and inflamed duodenal wall, etc. A few studies have reported that the inadequate duodenal stump closure was considered as the most common contributor to DSL. Therefore, adequate duodenal stump closure plays an important role in reducing the incidence of DSL in patients who undergo LG. In previous studies, absence of manual reinforcement over the duodenal stump in OG and LG was considered to be an independent and specific risk factor for DSL, and could increase the incidence or severity of DSL necessitated reoperation after LG. These results suggest that the proper duodenal stump reinforcement could be a crucial surgical step to ensure meticulous duodenal stump closure in LG. Seromuscular hand‐sewn buried reinforcement of the duodenal stump that is transected using a linear stapler is considered a safe, feasible, popular and reproducible technique for duodenal stump closure in OG. Some surgeons have attempted laparoscopic seromuscular hand‐sewn buried reinforcement of the stapled duodenal stump in LG. However, this is always a technical‐challenging, time‐consuming procedure because it mandates close coordination between the surgeon and assistant. Currently, no optimal method is available to reinforce the stapled duodenal stump and ensure adequate closure in patients who undergo LG as OG. It is essential to establish a simple, safe, time‐saving, classic, and reproducible procedure for seromuscular hand‐sewn buried reinforcement along the stapled duodenal stump during TLG (no salvaged way to extracorporeally reinforce the stapled duodenal stump as in LAG). Such a method should be useful even for LAG to overcome the disadvantages of limited manipulation through a small or an extended laparotomy incision for extracorporeal