Case Report: Itihaas's Omega Anastomosis for Distal Gastrectomy

Abstract This study introduces a novel reconstruction method for the upper gastrointestinal (UGI) tract following distal gastrectomy, called Itihaas's Omega Anastomosis. This technique is designed to preserve the natural anatomical connection between the stomach and duodenum. It serves as an alternative anastomotic approach in cases where Billroth I (gastroduodenostomy) cannot be performed due to tension or other technical limitations. Itihaas's Omega Anastomosis also facilitates access for endoscopic retrograde cholangiopancreatography (ERCP) and can be considered a complementary option to the traditional Billroth II (gastrojejunostomy) with Braun (jejunojejunostomy) anastomosis. The technique involves three side-to-side anastomoses: gastrojejunostomy, jejunojejunostomy, and jejunoduodenostomy. The inclusion of the jejunoduodenostomy establishes a direct route for food to pass from the stomach to both the duodenum and jejunum, potentially helping to mitigate dumping syndrome. Additionally, it provides a viable route for ERCP when necessary. The gastrojejunostomy allows immediate passage to the jejunum, minimizing bile reflux, while also diverting gastric acid for neutralization, thereby reducing acid reflux. The jejunojejunostomy further prevents reflux of bile and pancreatic juices into the stomach. This technique was performed on two female patients, aged 67 and 71, who had adenocarcinoma of the gastric antrum. Postoperative outcomes were favorable, with no major complications. Both patients exhibited smooth oral contrast passage with no signs of anastomotic leakage. They resumed semi-solid diets successfully and were discharged without experiencing reflux symptoms. Itihaas's Omega Anastomosis shows promise in reducing acid reflux and enhancing postoperative quality of life for patients undergoing distal gastrectomy. By preserving natural anatomy and function while minimizing reflux, it may offer advantages over conventional anastomoses. However, further studies are needed to validate these preliminary findings and compare long-term outcomes with existing techniques.