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Xie H, Wu F, Huang C, Chen Q, Ni Z, Wang S, Ge B, Liu L, Huang Q. Tranditional Roux-en-Y vs Uncut Roux-en-Y in Laparoscopic Distal Gastrectomy: a Randomized Controlled Study. J Gastrointest Surg 2023:10.1007/s11605-023-05644-6. [PMID: 36917403 DOI: 10.1007/s11605-023-05644-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/11/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Traditional Roux-en-Y may cause Roux-en-Y stasis syndrome (RSS), and Uncut Roux-en-Y was proposed to solve this problem. However, because afferent loop recanalization may occur after surgery, its clinical application remains controversial. The purpose of this study was to compare the long-term outcomes of these two gastrointestinal reconstruction methods. METHODS A total of 108 patients who received laparoscopic-assisted distal gastrectomy (LADG) were enrolled; 57 were randomly divided into the Uncut Roux-en-Y (URY) group, and 51 were divided into the Roux-en-Y (RY) group. Patients were followed up for 1 year to evaluate variables, including the following: (1) Assessments for RSS; (2) Preoperative and postoperative Gastrointestinal Symptom Rating Scale (GSRS) scores; (3) Postoperative gastroscopy to assess the occurrence of reflux esophagitis (Los Angeles classification), residual gastritis and bile reflux 1 year after surgery; and (4) Upper gastrointestinal radiography to evaluate whether recanalization occurred in patients in the URY group after surgery. RESULTS At 1 year after surgery, a total of 42 patients (73.7%) developed afferent loop recanalization. The incidence of RSS was not different between the two groups (OR, 1.301 [95% CI, 0.482 to 3.509]; P = 0.603P = 0.603). The GSRS score was higher in the URY group (P < 0.001). Postoperative gastroscopy showed that the incidence of bile reflux (P < 0.001) and the grade of residual gastritis (P < 0.001) were significantly higher in the URY group, but the grade of reflux esophagitis was not significantly different (P = 0.447, [95% CI, 0.437 to 0.457]P = 0.397). CONCLUSIONS Compared with traditional Roux-en-Y anastomosis, due to the high recanalization rate, the URY group developed more severe gastrointestinal symptoms, the incidence of bile reflux and the grade of residual gastritis increased and the incidence of postoperative RSS was not reduced.
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Affiliation(s)
- Huahao Xie
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Feng Wu
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of General Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Zhejiang, China
| | - Chenshen Huang
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Quanning Chen
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhizhan Ni
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Song Wang
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bujun Ge
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Liming Liu
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China. .,Department of General Surgery, Shanghai Jing'an Shibei Hospital, Shanghai, China.
| | - Qi Huang
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
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2
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Zhang H, Zhai Z, Cao K, Li G, Wang Z, Han J. Short-term outcomes of sleeve gastrectomy plus uncut jejunojejunal bypass (SG-uncut JJB) in patients with obesity: a preliminary prospective cohort study. LANGENBECK'S ARCHIVES OF SURGERY 2023; 408:9. [PMID: 36602593 DOI: 10.1007/s00423-022-02742-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/27/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To compare the safety, weight loss, and metabolic outcomes of patients with obesity with sleeve gastrectomy (SG) or sleeve gastrectomy plus uncut jejunojejunal bypass (SG-uncut JJB). METHODS This prospective study included patients with BMIs ≥ 32.5 kg/m2 or refractory metabolic disorders undergoing SG or SG-uncut JJB between January and December 2020 in our hospital (NCT04534504). Weight loss, metabolic outcomes, surgical results, and complaints during 1-year follow-up were compared between two groups. RESULTS Forty-seven patients were enrolled, 26 in the SG and 21 in the SG-uncut JJB groups. A longer operative time was observed in the SG-uncut JJB than in the SG group (140 (110-180) min vs. 90 (70-180) min, P = 0.001). No significant differences were found in complications. Total weight loss (TWL%) and excess weight loss (EWL%) in both groups increased with the duration of follow-up (P = 0.001). TWL% was greater at 1 month ((11.1 ± 2.4)% vs. (8.2 ± 4.4)%, P = 0.011] and 12 months [(29.7 ± 6.9)% vs. (20.3 ± 7.2)%, P = 0.001) with SG-uncut JJB than with SG. SG-uncut JJB and SG had similar metabolic outcomes and complaints during the 1-year follow-up, but less nausea was reported with SG-uncut JJB (9.2% vs. 46.2%, P = 0.006). CONCLUSION In short-term follow-up, SG-uncut JJB was a safe and effective bariatric surgery procedure in patients with obesity.
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Affiliation(s)
- Haoyu Zhang
- The General Surgery Department of Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Lu, Chaoyang District, Beijing, People's Republic of China, 100020
| | - Zhiwei Zhai
- The General Surgery Department of Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Lu, Chaoyang District, Beijing, People's Republic of China, 100020
| | - Ke Cao
- The General Surgery Department of Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Lu, Chaoyang District, Beijing, People's Republic of China, 100020
| | - Ganbin Li
- The General Surgery Department of Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Lu, Chaoyang District, Beijing, People's Republic of China, 100020
| | - Zhenjun Wang
- The General Surgery Department of Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Lu, Chaoyang District, Beijing, People's Republic of China, 100020
| | - Jiagang Han
- The General Surgery Department of Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Lu, Chaoyang District, Beijing, People's Republic of China, 100020.
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3
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Yogo K, Sando M, Kobayashi R, Yano G, Ohara N, Kawai K, Takagi K, Kawai S, Kamiya S. Jejunogastric intussusception after pancreaticoduodenectomy: a case report. Surg Case Rep 2022; 8:91. [PMID: 35534691 PMCID: PMC9086021 DOI: 10.1186/s40792-022-01424-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Jejunogastric intussusception (JGI) is a rare, but potentially fatal complication that can occur following gastric surgery, and the reported incidence of JGI is as low as 0.1%. Early diagnosis and treatment are critical for JGI to prevent major complications such as bowel necrosis and death. Although emergency surgery is the standard treatment, endoscopic reduction has also been reported to be effective in JGI patients without bowel necrosis. Several early recurrent cases treated with surgical or endoscopic reduction have been reported. We report an extremely rare case of JGI after pancreaticoduodenectomy (PD) using Child’s procedure that was successfully treated with surgical reduction and fixation.
Case presentation
An 81-year-old man who had undergone PD using Child’s procedure 3 years ago presented to our hospital with epigastric pain and nausea. His vital signs were stable, and abdominal examination revealed mild tenderness with a palpable mass in the mid-epigastrium. Abdominal computed tomography (CT) and gastroscopy revealed a JGI of the efferent loop, and exploratory laparotomy was immediately performed. During the operation, the efferent loop showed no adhesions and was intussuscepted through the gastrojejunostomy into the gastric lumen. An incision in the anterior wall of the stomach revealed no evidence of ischemia of the intussusceptum. The efferent loop was reduced using Hutchinson’s maneuver and fixed to the afferent loop to prevent a recurrence. The postoperative course was uneventful, and there was no sign of recurrence 12 months postoperatively.
Conclusions
JGI after PD is an extremely rare, but has severe complications. Surgery might be the optimal treatment for JGI in terms of preventing recurrence, even in cases without bowel necrosis.
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Yan Y, Wang D, Liu Y, Lu L, Wang X, Zhao Z, Li C, Liu J, Li W, Fu W. Optimal Reconstruction After Laparoscopic Distal Gastrectomy: A Single-Center Retrospective Study. Cancer Control 2022; 29:10732748221087059. [PMID: 35412845 PMCID: PMC9121732 DOI: 10.1177/10732748221087059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives Although laparoscopic distal gastrectomy has been widely used for distal
gastric cancer, the best functional reconstruction type has not yet been
established. Based on previous experience, we propose a modified uncut
Roux-en-Y anastomosis. This study aimed to compare the outcomes of different
intracorporeal anastomoses after laparoscopic distal gastrectomy. Methods From April 2015 to August 2020, the data of 215 patients who underwent
laparoscopic distal gastrectomy was collected. The patients were divided
into 4 groups according to the digestive tract reconstruction method,
Billroth-I, Billroth-II, Roux-en-Y, and the modified uncut Roux-en-Y.
Clinicopathologic characteristics, surgery details, short-term outcomes, and
postoperative nutritional status were analyzed. Results The operation time of Billroth-I anastomosis was significantly shorter (216.2
± 25.8 min, P < .001) than that of other methods. There was no difference
in postoperative complications and OS among the 4 reconstruction methods.
The incidences of esophagitis, gastritis, and bile reflux were significantly
lower in the Roux-en-Y and uncut Roux-en-Y group (P < .001) 1 year after
surgery. And the postoperative albumin and PNI levels in uncut Roux-en-Y
group were higher than those in other groups(P < .05). On multivariate
analysis, age and reconstruction type were independently related to
esophagitis, gastritis, and bile reflux. Serum albumin and the prognostic
nutritional index were significantly higher in the uncut Roux-en-Y group
than other groups (P < .05). Conclusions All 4 reconstruction techniques are feasible and safe. The Roux-en-Y and
uncut Roux-en-Y are superior to Billroth-Ⅰ and Billroth-Ⅱ+Braun in terms of
reflux esophagitis, gastritis, and bile reflux. Uncut Roux-en-Y may result
in better PNI than the others.
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Affiliation(s)
- Yongjia Yan
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Daohan Wang
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Yubiao Liu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Li Lu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Xi Wang
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Zhicheng Zhao
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Chuan Li
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Jian Liu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Weidong Li
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Weihua Fu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
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5
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Wu F, Ni Z, Diao H, Huang C, Wang S, Ge B, Huang Q. Recanalization in Uncut Roux-en-Y Reconstruction: An Animal Experiment and a Clinical Study. Front Surg 2021; 8:644864. [PMID: 34422889 PMCID: PMC8377251 DOI: 10.3389/fsurg.2021.644864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/13/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Because of the challenge of jejunal closure recanalization, uncut Roux-en-Y reconstruction remains controversial. This study aimed to investigate the incidence of recanalization after uncut Roux-en-Y reconstruction in pigs and a small number of patients. Methods: Twenty miniature pigs were subjected to distal gastrectomy and uncut Roux-en-Y reconstruction using various rows of linear staplers to block the intestine. The pigs were sacrificed, and the incidence of recanalization was investigated 1 month after the operation. From December 2018 to June 2019, 10 patients with gastric cancer who had undergone elective laparoscopy-assisted distal gastrectomy and uncut Roux-en-Y reconstruction were included in this study. The primary study outcome was recanalization of the afferent limb, demonstrated by gastrointestinal radiography 1, 3, and 6 months after surgery. Various numbers of staple lines across the afferent jejunal limb were applied for closure: 2 staple lines in 2 pigs, 4 staple lines in 6 pigs, 6 staple lines in 8 pigs, and 8 staple lines in 4 pigs. Results: Complete recanalization was detected in all 20 pigs 1 month postoperatively. Recanalization was detected in five cases (50%) by gastrointestinal radiography. Among them, 1 case of recanalization was found in the 1st month after the operation, 2 cases were found in the 3rd month, and another 2 cases were found in the 6th month. Bile reflux was detected by endoscopy in 2 patients with recanalization. Conclusions: The occurrence of afferent limb recanalization after uncut Roux-en-Y reconstruction is high, and using additional staplers alone cannot decrease the incidence of recanalization. Based on our study, uncut Roux-en-Y reconstruction is not recommended.
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Affiliation(s)
- Feng Wu
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of General Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Zhejiang, China
| | - Zhizhan Ni
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hongliang Diao
- Department of General Surgery, Karamay Central Hospital, Karamay, China
| | - Chenshen Huang
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Song Wang
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bujun Ge
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qi Huang
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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6
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Hangtian C, Huabing H, Tianhang L, Xiaoyi Y, Guoen F. Isoperistaltic versus antiperistaltic uncut Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a propensity score matched analysis. BMC Surg 2020; 20:274. [PMID: 33160348 PMCID: PMC7648979 DOI: 10.1186/s12893-020-00936-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022] Open
Abstract
Background The uncut Roux-en-y anastomosis (URYA) has some clinical advantages after distal gastrectomy (DG). Little evidence exists regarding the influence of peristalsis on this anastomosis. We aimed to evaluate short-term outcomes of isoperistaltic URYA (iso-URYA) comparing with antiperistaltic URYA (anti-URYA) after DG. Method Patients who underwent URYA for gastric cancer (GC) between January 2016 and December 2018 were selected from Shanghai Changhai Hospital, Navy Medical University. Short-term outcomes were compared between iso-URYA group and anti-URYA group after 1:1 propensity score matching (PSM). Result A total of 612 patients were selected. 392 patients underwent iso-URYA and 220 patients underwent anti-URYA. After PSM, 183 patients for each group were included in the final analysis. No differences were found between them in terms of short-term complications, nutritional status and quality of life 1 year after surgery. Endoscopic examination showed that anti-URYA group had more severe gastritis (P = 0.036). In addition, the recanalization rate was significantly higher when the afferent loop was blocked by stapler. Conclusion The iso-URYA and anti-URYA group present similar results in short term outcomes. Ligation blocking afferent loop leads to lower recanalization rate.
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Affiliation(s)
- Cui Hangtian
- Department of Gastrointestinal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Huang Huabing
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Luo Tianhang
- Department of Gastrointestinal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Yin Xiaoyi
- Department of Gastrointestinal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Fang Guoen
- Department of Gastrointestinal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China. .,Department of General Surgery, Changhai Hospital, No.168 Changhai Road, Yangpu District, Shanghai, 200433, China.
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7
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Wang J, Wang Q, Dong J, Yang K, Ji S, Fan Y, Wang C, Ma Q, Wei Q, Ji G. Total Laparoscopic Uncut Roux-en-Y for Radical Distal Gastrectomy: An Interim Analysis of a Randomized, Controlled, Clinical Trial. Ann Surg Oncol 2020; 28:90-96. [PMID: 32556870 DOI: 10.1245/s10434-020-08710-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The traditional Billroth II and Roux-en-Y anastomosis after laparoscopic distal gastrectomy for gastric cancer are associated with bile reflux gastritis and roux stasis syndrome, respectively. The uncut Roux-en-Y gastrojejunostomy can decrease the incidence of these complications by blocking the entry of bile and pancreatic juice into the residual stomach and retaining the impulses originating from the duodenum. The purpose of the present study was to compare the short-term outcomes of uncut Roux-en-Y (URY) and Billroth II combined Braun (BB) anastomosis. METHODS In this prospective, multi-center, two-arm randomized controlled trial, 124 patients with advanced distal gastric cancer were randomized into two groups: URY (n = 62) and BB (n = 62) groups. RESULTS The mean gastric juice pH was significantly lower in the URY group compared with the BB group (3.94 ± 0.71 vs. 5.83 ± 0.91, P < 0.0001). The bile reflux gastritis at 3 months (P < 0.0001) and 6 months (P = 0.002) was significantly more frequent in the BB group. No recanalization occurred in the URY group, and no significant difference was found between the two groups in terms of mean operative time (P = 0.69), mean time to perform anastomosis (P = 0.86), mean estimated blood loss (P = 0.77), mean number of harvested lymph nodes (P = 0.90), time to first passage of flatus or defecation (P = 0.87), postoperative hospital stay (P = 0.83), and the incidence of postoperative complications (P = 0.70). CONCLUSIONS URY anastomosis is associated with a significantly lower incidence of bile reflux gastritis and roux stasis syndrome compared with BB anastomosis.
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Affiliation(s)
- Juan Wang
- Department of Digestive Surgery, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Quan Wang
- Department of Digestive Surgery, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Junqiang Dong
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kelu Yang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Sheqing Ji
- Henan Cancer Hospital and Zhengzhou University Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Yong Fan
- Department of Minimally Invasive Surgery, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Chen Wang
- Department of Minimally Invasive Surgery, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Qi Ma
- Henan Cancer Hospital and Zhengzhou University Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Qiuya Wei
- Department of Minimally Invasive Surgery, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Gang Ji
- Department of Digestive Surgery, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
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8
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Kim A, Yoo MW. Uncut Roux-en-Y gastrojejunostomy after totally laparoscopic distal gastrectomy: Learning curve and surgical outcomes. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2020; 16:46-51. [PMID: 36945307 PMCID: PMC9942719 DOI: 10.14216/kjco.20008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 11/07/2022]
Abstract
Purpose Totally laparoscopic distal gastrectomy (TLDG) is now widely used for early gastric cancer patients, but the selection of a reconstruction method after TLDG is still controversial. Roux-en-Y gastrojejunostomy is increasingly used in expectation of less gastritis and alkaline reflux despite its technical difficulty. The uncut Roux-en-Y gastrojejunostomy (uRYGJ) retains the advantages of Roux-en-Y reconstruction but helps prevent Roux stasis syndrome. The present study aims to introduce a single surgeon's experience of TLDG with uRYGJ and analyze the learning curve and surgical outcomes. Methods We retrospectively reviewed the medical records of 124 consecutive patients who underwent TLDG with uRYGJ performed by a single surgeon between July 2014 and August 2015 at Asan Medical Center. The baseline characteristics and surgical outcomes were analyzed, and the learning curve was drawn based on the power-law model. Results The mean total operative time was 165 minutes, and the average length of hospital stay was 6.6 days. Complications included two cases of duodenal stump leakage, two intra-abdominal bleeding, two intra-abdominal fluid collection, one wound problem, two anastomotic strictures, 14 ileus, and no anastomotic leakage. There were five cases of endoscopically proven reflux gastritis/esophagitis and no Roux stasis syndrome. There were five recurrences and one mortality during the follow-up period. The learning curve leveled at the 15th case. Conclusion The results of our study showed the safety and feasibility of uRYGJ, and that the technical difficulty of the procedure can be overcome with a short learning curve for experienced surgeons.
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Affiliation(s)
- Amy Kim
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
- Division of Upper Intestinal Surgery, Department of Surgery, Korea University Ansan Hospital, Ansan,
Korea
| | - Moon-Won Yoo
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
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9
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Ma Y, Li F, Zhou X, Wang B, Lu S, Wang W, Yu S, Fu W. Four reconstruction methods after laparoscopic distal gastrectomy: A systematic review and network meta-analysis. Medicine (Baltimore) 2019; 98:e18381. [PMID: 31860999 PMCID: PMC6940138 DOI: 10.1097/md.0000000000018381] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is no consensus regarding which reconstruction methods are superior after laparoscopic distal gastrectomy (LDG). This study compared four reconstruction methods after LDG for gastric cancer. METHODS Literature in EMBASE, PubMed, and the Cochrane Library was screened to compare Billroth I (B-I), Billroth II (B-II), Roux-en-Y (RY), and uncut Roux-en-Y (URY) anastomoses after LDG for gastric cancer. A Bayesian network meta-analysis (NMA) was conducted to compare these methods. RESULTS Eighteen studies involving 4347 patients were eligible for our NMA. The operative time in RY anastomosis was longer than that in B-I and B-II anastomoses. Blood loss and risk of gastrointestinal motility dysfunction were greater with RY anastomosis than with URY or B-I anastomosis. Furthermore, URY anastomosis was superior to the other 3 reconstruction methods for preventing food residue. For remnant gastritis, RY anastomosis was significantly superior to B-I and B-II anastomoses, whereas URY anastomosis was significantly superior to B-II anastomosis. In addition, RY and URY anastomoses were better than B-I and B-II anastomoses for preventing bile reflux. CONCLUSIONS URY anastomosis tended to be a more favorable reconstruction method after LDG due to its operative simplicity and reduced long-term complications.
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10
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Yang L, Xu H, Zhang DC, Li FY, Wang WZ, Li Z, Wang LJ, Xu ZK. Uncut Roux-en-Y Reconstruction in a Laparoscopic Distal Gastrectomy: A Single-Center Study of 228 Consecutive Cases and Short-Term Outcomes. Surg Innov 2019; 26:698-704. [PMID: 31304882 DOI: 10.1177/1553350619860964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aims. We have established a procedure for uncut Roux-en-Y gastrojejunostomy after laparoscopic distal gastrectomy. This study aimed to evaluate the safety and technical feasibility of the procedure for patients with distal gastric cancer according to the short-term outcomes. Methods. Two hundred and twenty-eight consecutive patients who underwent a laparoscopic distal gastrectomy with uncut Roux-en-Y gastrojejunostomy from September 2014 to August 2018 were reviewed retrospectively. All the laparoscopic operations were performed successfully without conversion to open surgery. Results. The mean operative duration was 178.28 ± 32.82 minutes, the mean anastomotic process duration was 28.22 ± 7.50 minutes, the average blood loss was 48.97 ± 29.16 mL, and the overall number of lymph nodes harvested was 37.16 ± 11.47. The mean time of out-of-bed ambulation, anal exsufflation, liquid-diet intake, and duration of hospital stay were 41.99 ± 18.37 hours, 69.57 ± 23.17 hours, 5.06 ± 1.09 days, and 8.77 ± 2.42 days, respectively. Fifteen patients suffered postoperative complications, and the overall incidence rate was 6.58% (15/228). Seventeen patients experienced afferent recanalization, the mean time of which was 11 months after the operation. Conclusion. The laparoscopic uncut Roux-en-Y reconstruction is safe and technically feasible, and it has inspiring short-term outcomes for patients undergoing distal gastrectomy.
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Affiliation(s)
- Li Yang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hao Xu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Dian-Cai Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Feng-Yuan Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Wei-Zhi Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zheng Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Lin-Jun Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ze-Kuan Xu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.,Nanjing Medical University, Nanjing, Jiangsu Province, China
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Park YS, Shin DJ, Son SY, Kim KH, Park DJ, Ahn SH, Park DJ, Kim HH. Roux Stasis Syndrome and Gastric Food Stasis After Laparoscopic Distal Gastrectomy with Uncut Roux-en-Y Reconstruction in Gastric Cancer Patients: A Propensity Score Matching Analysis. World J Surg 2019; 42:4022-4032. [PMID: 29915987 DOI: 10.1007/s00268-018-4715-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Uncut Roux-en-Y gastrojejunostomy (uRYGJ) was developed to prevent slow peristalsis in the Roux limb after Roux-en-Y gastrojejunostomy (RYGJ). This study compared the incidence of Roux stasis syndrome (RSS) and severe gastric food stasis in gastric cancer patients who underwent RYGJ or uRYGJ after laparoscopic curative distal gastrectomy. METHODS Between January 2006 and June 2012, 319 patients underwent RYGJ or uRYGJ. After covariates were adjusted by propensity score matching, 39 patients in the RYGJ group and 65 patients in the uRYGJ group were included in the final analysis. RSS was defined as the presence of symptoms, such as nausea, vomiting, and abdominal fullness, requiring refasting without ileus or obstruction within 30 days post-surgery. Gastric food stasis was measured endoscopically at 1 and 3 years after gastrectomy. RESULTS Operative outcomes and morbidities were similar between the two groups, whereas the incidence of RSS was higher in the RYGJ group than in the uRYGJ group, although the difference was not significant (7.7 vs. 0%; odds ratio (OR) 0.157; 95% confidence interval (CI) 0-1.059, p = 0.111). Comparison of endoscopic findings revealed that severe gastric stasis 1 year after surgery was significantly less frequent in the uRYGJ group (46.2 vs. 13.8%; OR 0.247; 95% CI 0.102-0.599, p = 0.002). The same result was reproduced 3 years after surgery (39.4 vs. 15.5%; OR 0.279; 95% CI 0.088-0.882, p = 0.030). CONCLUSIONS Compared with RYGJ, uRYGJ after laparoscopic distal gastrectomy is a safe and effective procedure for preventing severe postoperative gastric food stasis.
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Affiliation(s)
- Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Dong Joon Shin
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sang-Yong Son
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Ki-Hyun Kim
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Dong Jin Park
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea. .,Department of Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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12
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Wang Q, Ni Q, Yang K, Ji S, Fan Y, Wang C, Zhang W, Yan S, Ma Q, Wei Q, Zhang D, Yu J, Ji G. Laparoscopic uncut Roux-en-Y for radical distal gastrectomy: the study protocol for a multirandomized controlled trial. Cancer Manag Res 2019; 11:1697-1704. [PMID: 30863178 PMCID: PMC6389003 DOI: 10.2147/cmar.s170355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Gastric cancer is the third most common cause of cancer-related deaths and is the fifth highest incidence of cancer worldwide, especially in Eastern Asia, Central and Eastern Europe, and South America. Currently, surgery is the only curative treatment for gastric cancer; however, digestive tract reconstruction after distal gastrectomy for gastric cancer is controversial due to the postoperative complications such as reflux gastritis. There is an increasing trend toward laparoscopic uncut Roux-en-Y (URY) for radical gastrectomy. However, evidence on the feasibility of this procedure in patients undergoing laparoscopic radical distal gastrectomy is still absent. Thus, a prospective randomized trial is warranted. This is a prospective, multicenter, two-arm randomized controlled trial in which 210 patients will be randomly assigned to two groups: laparoscopic URY (n=105) and laparoscopic Billroth II plus Braun anastomosis (n=105). Each participant must be pathologically diagnosed with gastric cancer and undergo laparoscopic radical gastrectomy at Xijing Hospital and other four hospitals. The laparoscopic URY procedure is based on the Billroth II gastrojejunostomy plus Braun anastomosis, and then blocked the jejunum input loop at the stump–jejunal anastomosis. The patients’ demographic and pathological characteristics will be recorded. The total and oral nutritional intake, general data, total serum protein, serum albumin, blood glucose, and temperature will be recorded before surgery and at the time of hospitalization. Postoperative adverse events will also be recorded, as well as at follow-up appointments at three months and six months after surgery. The rate of reflux gastritis will represent the primary endpoint, and other secondary endpoints, which are all recorded.
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Affiliation(s)
- Quan Wang
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
| | - Qingrong Ni
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
| | - Kelu Yang
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
| | - Sheqing Ji
- Department of General Surgery, Henan Cancer Hospital& Zhengzhou University Cancer Hospital, Zhengzhou University, Zhengzhou 450003, China
| | - Yong Fan
- Department of Minimally Invasive Surgery, The Second Hospitalof Lanzhou University, Lanzhou University, Lanzhou 730000, China
| | - Chen Wang
- Department of Minimally Invasive Surgery, The Second Hospitalof Lanzhou University, Lanzhou University, Lanzhou 730000, China
| | - Wenbin Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospitalof Xinjiang Medical University, Xinjiang Medical University, Urumqi 830000, China
| | - Su Yan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qinghai University, Qinghai University, Xining 810000, China
| | - Qi Ma
- Department of General Surgery, Henan Cancer Hospital& Zhengzhou University Cancer Hospital, Zhengzhou University, Zhengzhou 450003, China
| | - Qiuya Wei
- Department of Minimally Invasive Surgery, The Second Hospitalof Lanzhou University, Lanzhou University, Lanzhou 730000, China
| | - Di Zhang
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
| | - Juan Yu
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
| | - Gang Ji
- Department of Digestive Surgery, Xijing Hospital of Digestive Disease, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China,
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Chen XJ, Chen YZ, Chen DW, Chen YL, Xiang J, Lin YJ, Chen S, Peng JS. The Development and Future of Digestive Tract Reconstruction after Distal Gastrectomy: A Systemic Review and Meta-Analysis. J Cancer 2019; 10:789-798. [PMID: 30854084 PMCID: PMC6400796 DOI: 10.7150/jca.28843] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/09/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Billroth I, Billroth II, Roux-en-Y, and Un-cut Roux-en-Y are common reconstruction techniques of distal gastrectomy. Which of these techniques is better has yet to be established. We performed an indirect comparison to evaluate which technique was optimal for preventing reflux symptoms. Methods: The PubMed, Cochrane Collaboration, Embase, ClinicalTrials.gov and Web of Science databases were searched to identify clinical trials that compared at least two of the reconstruction skills among Billroth I, Billroth II, Roux-en-Y, and Un-cut Roux-en-Y. Data on reflux gastritis, intraoperative blood loss, bile reflux and postoperative hospital stays were extracted from the included clinical trials for meta-analysis using a random-effects model. Results: Twenty-four articles that included 5419 individuals were assessed as eligible for meta-analysis. The indirect comparison suggested that Roux-en-Y reconstruction significantly reduces reflux gastritis, and it tended to rank first and had the highest probability of preventing bile reflux. No significant differences were found in intraoperative blood loss and postoperative hospital stays. Conclusion: This indirect comparison suggested some superiority of Roux-en-Y reconstruction after distal gastrectomy. Further perspective clinical trials are required to provide evidence for the optimal reconstruction skill.
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Affiliation(s)
- Xi-Jie Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Yun-Zhi Chen
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-Sen University, and Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, 510630, P. R. China
| | - Dong-Wen Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Ying-Liang Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Jun Xiang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Yi-Jia Lin
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Shi Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Jun-Sheng Peng
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
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14
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Sun MM, Fan YY, Dang SC. Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis. World J Gastroenterol 2018; 24:2628-2639. [PMID: 29962819 PMCID: PMC6021772 DOI: 10.3748/wjg.v24.i24.2628] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/05/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare uncut Roux-en-Y (U-RY) gastrojejunostomy with Roux-en-Y (RY) gastrojejunostomy after distal gastrectomy (DG) for gastric cancer.
METHODS A literature search was conducted in Pubmed, Embase, Web of Science, Cochrane Library, Science Direct, Chinese National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database to identify studies comparing U-RY with RY after DG for gastric cancer until the end of December 2017. Pooled odds ratio or weighted mean difference with 95% confidence interval was calculated using either fixed- or random-effects models. Perioperative outcomes such as operative time, intraoperative blood loss, and hospital stay; postoperative complications such as anastomotic bleeding, stricture and ulcer, reflux gastritis/esophagitis, delayed gastric emptying, and Roux stasis syndrome; and postoperative nutritional status (serum hemoglobin, total protein, and albumin levels) were the main outcomes assessed. Meta-analyses were performed using RevMan 5.3 software.
RESULTS Two randomized controlled trials and four nonrandomized observational clinical studies involving 403 and 488 patients, respectively, were included. The results of the meta-analysis showed that operative time [weighted mean difference (WMD): -12.95; 95%CI: -22.29 to -3.61; P = 0.007] and incidence of reflux gastritis/esophagitis (OR: 0.40; 95%CI: 0.20-0.80; P = 0.009), delayed gastric emptying (OR: 0.29; 95%CI: 0.14-0.61; P = 0.001), and Roux stasis syndrome (OR: 0.14; 95%CI: 0.04-0.50; P = 0.002) were reduced; and the level of serum albumin (WMD: 0.71; 95%CI: 0.24-1.19; P = 0.003) was increased in patients undergoing U-RY reconstruction compared with those undergoing RY reconstruction. No differences were found with respect to intraoperative blood loss, hospital stay, anastomotic bleeding, anastomotic stricture, anastomotic ulcer, the levels of serum hemoglobin, and serum total protein.
CONCLUSION U-RY reconstruction has some clinical advantages over RY reconstruction after DG.
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Affiliation(s)
- Ming-Ming Sun
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Yi-Yi Fan
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Sheng-Chun Dang
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
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15
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Yang D, He L, Tong WH, Jia ZF, Su TR, Wang Q. Randomized controlled trial of uncut Roux-en-Y vs Billroth II reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis? World J Gastroenterol 2017; 23:6350-6356. [PMID: 28974902 PMCID: PMC5603502 DOI: 10.3748/wjg.v23.i34.6350] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/08/2017] [Accepted: 08/08/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and Billroth II reconstruction.
METHODS A total of 158 patients who underwent laparoscopy-assisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University (Changchun, China) between February 2015 and February 2016 were randomized into two groups: uncut Roux-en-Y (group U) and Billroth II group (group B). Postoperative complications and relevant clinical data were compared between the two groups.
RESULTS According to the randomization table, each group included 79 patients. There was no significant difference in postoperative complications between groups U and B (7.6% vs 10.1%, P = 0.576). During the postoperative period, group U stomach pH values were lower than 7 and group B pH values were higher than 7. After 1 year of follow-up, group B presented a higher incidence of biliary reflux and alkaline gastritis. However, histopathology did not show a significant difference in gastritis diagnosis (P = 0.278), and the amount of residual food and gain of weight between the groups were also not significantly different. At 3 mo there was no evidence of partial recanalization of uncut staple line, but at 1 year the incidence was 13%.
CONCLUSION Compared with Billroth II reconstruction, uncut Roux-en-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn. Despite the incidence of recanalization, uncut Roux-en-Y should be widely applied.
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Affiliation(s)
- Dong Yang
- Department of Gastrointestinal and Anal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Liang He
- Department of Gastrointestinal and Anal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Wei-Hua Tong
- Department of Gastrointestinal and Anal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zhi-Fang Jia
- Division of Clinical Research, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Tong-Rong Su
- Department of Gastrointestinal and Anal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Quan Wang
- Department of Gastrointestinal and Anal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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16
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Huang Y, Wang S, Shi Y, Tang D, Wang W, Chong Y, Zhou H, Xiong Q, Wang J, Wang D. Uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Expert Rev Gastroenterol Hepatol 2016; 10:1341-1347. [PMID: 27748146 DOI: 10.1080/17474124.2016.1248404] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Uncut Roux-en-Y gastrojejunostomy is a modification of the Billroth II procedure with Braun anastomosis, in which a jejunal occlusion is fashioned to avoid the Roux Stasis Syndrome. This review aimed to summarize the current knowledge about the uncut Roux-en-Y anastomosis operation, so that surgeons may be able to make informed decisions about its clinical application. Additionally, we hope that our findings will guide future research on this topic. Areas covered: The original uncut technique was associated with dehiscence or recanalization of the jejunal occlusion, and was therefore not widely applied. However, with recent improvements in the method of jejunal occlusion, the uncut Roux-en-Y reconstruction may be an appropriate alternative for digestive tract reconstruction after distal gastrectomy. This review summarizes the basic research on and clinical applications of uncut Roux-en-Y gastrojejunostomy from the following several aspects: origin of the uncut reconstruction technique, rationale for uncut reconstruction based on data from animal experiments, clinical results of the uncut reconstruction, recanalization and its countermeasures, and so on. Expert commentary: The uncut Roux-en-Y gastrojejunostomy is a controversial yet promising method of gastrointestinal reconstruction after distal gastrectomy. Prospective randomized controlled trials and long-term follow-up outcomes are required to support the modified technique in the future.
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Affiliation(s)
- Yuqin Huang
- a Dalian Medicine University , DaLian , P. R. China
- b Department of Gastrointestinal Surgery , Subei People's Hospital of Jiangsu Province , Yangzhou , P. R. China
| | - Sen Wang
- c The First Clinical Medical College , Nanjing Medical University , Nanjing , P. R. China
| | - Youquan Shi
- a Dalian Medicine University , DaLian , P. R. China
- b Department of Gastrointestinal Surgery , Subei People's Hospital of Jiangsu Province , Yangzhou , P. R. China
| | - Dong Tang
- b Department of Gastrointestinal Surgery , Subei People's Hospital of Jiangsu Province , Yangzhou , P. R. China
| | - Wei Wang
- b Department of Gastrointestinal Surgery , Subei People's Hospital of Jiangsu Province , Yangzhou , P. R. China
| | - Yang Chong
- b Department of Gastrointestinal Surgery , Subei People's Hospital of Jiangsu Province , Yangzhou , P. R. China
| | - Huaicheng Zhou
- b Department of Gastrointestinal Surgery , Subei People's Hospital of Jiangsu Province , Yangzhou , P. R. China
| | - Qingquan Xiong
- d Xiangya School of Medicine , Central South University , Changsha , P. R. China
| | - Jie Wang
- a Dalian Medicine University , DaLian , P. R. China
- b Department of Gastrointestinal Surgery , Subei People's Hospital of Jiangsu Province , Yangzhou , P. R. China
| | - Daorong Wang
- b Department of Gastrointestinal Surgery , Subei People's Hospital of Jiangsu Province , Yangzhou , P. R. China
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17
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Gong JQ, Cao YK, Zhang GH, Wang PH, Luo GD. Uncut Esophagojejunostomy with Double Jejunal Pouch: An Alternative Reconstruction Method that Improves the Quality of Life of Patients after Total Gastrectomy. J INVEST SURG 2016; 30:125-132. [DOI: 10.1080/08941939.2016.1230249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) interferes considerably with the anatomy and physiology of the gastrointestinal tract. The study of intestinal permeability can provide important information regarding changes in the structure and function of the mucosal barrier after the procedure. METHODS The urinary excretion rates of lactulose and mannitol after oral intake of both substances were evaluated. We also evaluated the lactulose/mannitol excretion ratio. Tests were performed during the preoperative period (T0), at the first postoperative month (T1), and at the sixth postoperative month (T6). RESULTS The study included 16 morbidly obese patients. The excretion rate of mannitol was significantly lower at T1 compared with T0 and T6 (p = 0.003). There was no significant difference in the excretion rates of lactulose or in the lactulose/mannitol ratio during the three periods. Six patients (37.5%) exhibited a considerable increase in the excretion rate of lactulose at T6 (4-73 times higher than the preoperative value), accompanied by proportional variations in the lactulose/mannitol ratio. CONCLUSIONS The significant increase in mannitol excretion rate from T1 to T6 most likely reflects the occurrence of intestinal adaptation (mucosal hyperplasia), which would tend to minimize the malabsorption of macronutrients. A subgroup of patients who undergo RYGB exhibit pronounced increase in their intestinal permeability (assessed by the lactulose/mannitol ratio and the lactulose excretion rate) at T6.
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Simper SC, Erzinger JM, McKinlay RD, Smith SC. Laparoscopic reversal of gastric bypass with sleeve gastrectomy for treatment of recurrent retrograde intussusception and Roux stasis syndrome. Surg Obes Relat Dis 2010; 6:684-8. [DOI: 10.1016/j.soard.2010.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 07/26/2010] [Accepted: 08/01/2010] [Indexed: 11/16/2022]
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Dutra RA, Araújo WM, Andrade JID. The effects of Roux-en-Y limb length on gastric emptying and enterogastric reflux in rats. Acta Cir Bras 2009; 23:179-83. [PMID: 18372964 DOI: 10.1590/s0102-86502008000200011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 12/12/2007] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To assess the effects of Roux-en-Y jejunal limb length on gastric emptying and enterogastric reflux. METHODS Seventy male Wistar rats were submitted to antrectomy with Roux-en-Y reconstruction and then were divided into two groups of 35 animals. Group A, short limb (7.5 cm) and Group B, standard limb (15 cm). Group A and B were subdivided into five subgroups each in order to study enterogastric reflux at 30 and 60 minutes and to evaluate gastric emptying at 5, 10 and 15 minutes. In order to measure gastric emptying and enterogastric reflux, radiotracers 99m Tc-Phytate and 99m Tc-DISIDA were respectively used. RESULTS For gastric emptying, the radiotracer concentration was lower in Group A than in Group B after five minutes. The enterogastric reflux was present, but there were no significant differences between enterogastric reflux indexes concerning both A and B Groups. CONCLUSION A standard Roux limb, besides being unable to protect the stomach from the enterogastric reflux, may become a functional barrier for gastric emptying.
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Affiliation(s)
- Robson Azevedo Dutra
- Department of Surgery and Anatomy, University of São Paulo at Ribeirão Preto School of Medicine, São Paulo, Brazil.
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