Ecr60b

We used a modified delta-shaped gastroduodenostomy in the BI group. After the
duodenum was fully mobilized to 3-4 cm distal to the pylorus, the endoscopic
linear stapler (ECR60B, Ethicon, USA) was used to transect the duodenum by
rotating 90° from back to front and resected the stomach in the predetermined
position. The small incisions were made on the posterior side of the duodenum
and the greater curvature of the remnant stomach, respectively. The linear
stapler was inserted into the small holes, and the duodenal cutting edge was
rotated 90° counterclockwise, then we fired the stapler to complete
gastroduodenal anastomosis.

As for RY, the jejunum was cut off by (ECR45W, Ethicon, USA) at 25 cm away from
the Treitz ligament and the anti-mesentery side was open at 2 cm from the
jejunal stump after transecting the duodenum and stomach. The incision was
created on the greater curvature of the remnant stomach at 2 cm from the staple
line. Then the linear stapler (ECR60B, Ethicon, USA) was used to complete
gastrojejunostomy in an isoperistaltic antecolic fashion. The entry point was
closed and the jejunal stump was resected by another linear stapler. Finally, a
side-to-side jejuno-jejunal anastomosis was performed between the afferent and
the efferent loop 10 cm and 40 cm from gastrojejunostomy with linear stapler
(ECR45W, Ethicon, USA), respectively.

After transecting the duodenum and stomach, the incision was created on the
greater curvature of the remnant stomach at 2 cm from the staple line and the
anti-mesentery side of the jejunum 20 cm distal to the Treitz ligament. The
linear stapler (ECR60B, Ethicon, USA) was used to complete gastrojejunostomy in
an isoperistaltic antecolic fashion. A side-to-side jejuno-jejunal anastomosis
(Braun anastomosis) was performed 10 cm distal from the gastrojejunostomy using
linear stapler (ECR45W, Ethicon, USA).