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A modified uncut Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy: preliminary results and initial experience

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Abstract

Objective

To investigate the safety and feasibility of totally laparoscopic uncut Roux-en-Y anastomosis in the distal gastrectomy with D2 dissection for gastric cancer. We also summarized the preliminary experience of totally laparoscopic uncut Roux-en-Y anastomosis.

Methods

A retrospective analysis was done in 51 cases of total laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D2 dissection for gastric cancer in our hospital from September 2014 to December 2015.

Results

All of 51 cases underwent total laparoscopic uncut Roux-en-Y anastomosis. All the procedures were performed successfully. There were neither conversions to open surgery nor intraoperative complications in all 51 cases. In this study, the median operative time was 170 (135–210) min and the median time of anastomosis was 27 (24–41) min. The blood loss was 60 (30–110) ml. The time to flatus and length of postoperative hospital stay were 2 (1–3) days, and 8 (7–12) days, respectively. The mean lymph node harvest was 34 (18–49). One anastomotic bleeding occurred postoperatively which was cured by conservative treatment. No major postoperative complication occurred, such as anastomotic leak, anastomotic stenosis, and Roux stasis syndrome. After a short-term follow-up, no recanalization or reflux gastritis was encountered by endoscopy.

Conclusion

The totally laparoscopic uncut Roux-en-Y anastomosis in distal gastrectomy with lymph node dissection for gastric cancer is safe and feasible, with a very low rate of recanalization and reflux gastritis.

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References

  1. Kitano S, Iso Y, Moriyama M et al (1994) Laparoscopic-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4(2):146–148

    CAS  PubMed  Google Scholar 

  2. Kanaya S, Gomi T, Momoi H et al (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195(2):284–287

    Article  PubMed  Google Scholar 

  3. Uyama I, Sakurai Y, Komori Y et al (2005) Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer. Gastric Cancer 8(4):253–257

    Article  PubMed  Google Scholar 

  4. Kim JJ, Song KY, Chin HM et al (2008) Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 22(2):436–442

    Article  PubMed  Google Scholar 

  5. Kubo M, Sasako M, Gotoda T et al (2002) Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer 5:83–89

    Article  PubMed  Google Scholar 

  6. Nomura E, Lee SW, Tokuhara T et al (2013) Functional outcomes according to the size of the gastric remnant and the type of reconstruction following distal gastrectomy for gastric cancer: an investigation including total gastrectomy. Jpn J Clin Oncol 43(12):1195–1202

    Article  PubMed  Google Scholar 

  7. Association Japanese Gastric Cancer (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20(1):1–19

    Article  Google Scholar 

  8. Huang C, Lin M, Chen Q et al (2014) A modified delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: a safe and feasible technique. PLoS ONE 9(7):e102736

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shim JH, Oh SI, Yoo HM et al (2014) Roux-en-Y gastrojejunostomy after totally laparoscopic distal gastrectomy: comparison with Billorth II reconstruction. Surg Laparosc Endosc Percutan Tech 24(5):448–451

    Article  PubMed  Google Scholar 

  10. In Choi C, Baek DH, Lee SH et al (2016) Comparison between Billroth-II with Braun and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. J Gastrointest Surg 20(6):1083–1090

    Article  PubMed  Google Scholar 

  11. Hirao M, Takiguchi S, Imamura H et al (2013) Comparison of Billroth I and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: one-year postoperative effects assessed by a multi-institutional RCT. Ann Surg Oncol 20(5):1591–1597

    Article  PubMed  Google Scholar 

  12. Tanaka S, Matsuo K, Matsumoto H et al (2011) Clinical outcomes of Roux-en-Y and Billroth I reconstruction after a distal gastrectomy for gastric cancer: what is the optimal reconstructive procedure? Hepatogastroenterology 58(105):257–262

    PubMed  Google Scholar 

  13. Shah K, Johnny Nergard B, Stray Frazier K et al (2016) Long-term effects of laparoscopic Roux-en-Y gastric bypass on metabolic syndrome in patients with morbid obesity. Surg Obes Relat Dis 12(8):1449–1456

    Article  PubMed  Google Scholar 

  14. Di J, Zhang H, Yu H et al (2016) Effect of Roux-en-Y gastric bypass on the remission of type 2 diabetes: a 3-year study in Chinese patients with a BMI < 30 kg/m2. Surg Obes Relat Dis 12(7):1357–1363

    Article  PubMed  Google Scholar 

  15. Lee MS, Ahn SH, Lee JH et al (2012) What is the best reconstruction method after distal gastrectomy for gastric cancer? Surg Endosc 26(6):1539–1547

    Article  PubMed  Google Scholar 

  16. Petrakis J, Vassilakis JS, Karkavitsas N et al (1998) Enhancement of gastric emptying of solids by erythromycin in patients with Roux-en-Y gastrojejunostomy. Arch Surg 133:709–714

    Article  CAS  PubMed  Google Scholar 

  17. Hocking MP, Brunson ME, Vogel SB (1988) Effects of various prokinetic agents on post Roux-en-Y gastric emptying: experimental and clinical observation. Dig Dis Sci 33:1282–1287

    Article  CAS  PubMed  Google Scholar 

  18. Tu BN, Kelly KA (1995) Elimination of the Roux stasis syndrome using a new type of “uncut Roux” limb. Am J Surg 170(4):381–386

    Article  CAS  PubMed  Google Scholar 

  19. Noh SM (2000) Improvement of the Roux limb function using a new type of “uncut Roux” limb. Am J Surg 180(1):37–40

    Article  CAS  PubMed  Google Scholar 

  20. Ahn SH, Son SY, Lee CM et al (2014) Intracorporeal uncut Roux-en-Y gastrojejunostomy reconstruction in pure single-incision laparoscopic distal gastrectomy for early gastric cancer: unaided stapling closure. J Am Coll Surg 218(1):e17–e21

    Article  PubMed  Google Scholar 

  21. Yun SC, Choi HJ, Park JY et al (2014) Total laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy. Am Surg 80(2):E51–E53

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China

    Jun-Jun Ma, Lu Zang, Annie Yang, Wei-Guo Hu, Bo Feng, Feng Dong, Ming-Liang Wang, Ai-Guo Lu, Jian-Wen Li & Min-Hua Zheng

  2. Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China

    Jun-Jun Ma, Lu Zang, Annie Yang, Wei-Guo Hu, Bo Feng, Feng Dong, Ming-Liang Wang, Ai-Guo Lu, Jian-Wen Li & Min-Hua Zheng

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  1. Jun-Jun Ma
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  2. Lu Zang
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  3. Annie Yang
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  9. Jian-Wen Li
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  10. Min-Hua Zheng
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Correspondence to Lu Zang.

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Disclosures

Jun-Jun MA, Lu ZANG, Annie YANG, Wei-Guo Hu, Bo FENG, Feng DONG, Ming-Liang WANG, Ai-Guo LU, Jian-Wen LI, and Min-Hua ZHENG have no conflicts of interest or financial ties to disclose.

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Ma, JJ., Zang, L., Yang, A. et al. A modified uncut Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy: preliminary results and initial experience. Surg Endosc 31, 4749–4755 (2017). https://doi.org/10.1007/s00464-017-5551-8

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  • DOI: https://doi.org/10.1007/s00464-017-5551-8

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