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Duodenal stump reinforcement might reduce both incidence and severity of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer

  • Motonari Ri
  • Naoki HikiEmail author
  • Naoki Ishizuka
  • Satoshi Ida
  • Koshi Kumagai
  • Souya Nunobe
  • Manabu Ohashi
  • Takeshi Sano
Original Article

Abstract

Background

Although duodenal stump leakage (DSL) is a relatively rare complication after gastrectomy with Roux-en-Y (R-Y) reconstruction, it is difficult to treat and can be fatal. We investigated the impact of duodenal stump reinforcement on DSL after laparoscopic gastrectomy with R-Y reconstruction for gastric cancer.

Methods

This retrospective study of 965 patients with gastric cancer who underwent laparoscopic distal or total gastrectomy (LDG or LTG) with R-Y reconstruction compared surgical outcomes between two groups, the duodenal stump reinforcement group (reinforcement group) (n = 895) and that without duodenal stump reinforcement (non-reinforcement group) (n = 70).

Results

Mean operative duration was significantly longer in the reinforcement than in the non-reinforcement group (LDG; 291 min versus 258 min, p < 0.001, LTG; 325 min versus 285 min, p < 0.001). DSL occurred less frequently in the reinforcement than in the non-reinforcement group (0.67% vs. 5.71%, p < 0.001). Furthermore, non-reinforcement was an independent risk factor for DSL in multiple logistic regression analysis with adjustment for potential confounding factors. Patients with DSL in the non-reinforcement group all required re-operation, while all but one patient with DSL in the reinforcement group recovered with conservative management.

Conclusions

Duodenal stump reinforcement in laparoscopic gastrectomy with R-Y reconstruction may reduce the risk of DSL development and minimize its severity.

Keywords

Duodenal stump leakage Duodenal stump reinforcement Roux-en-Y reconstruction Laparoscopic distal gastrectomy Laparoscopic total gastrectomy 

Notes

Funding

The authors declare that this study have no external funding.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

Human rights statement

All procedures followed were in accordance with the ethical standards of the institutional and national committees governing human experimentation and in compliance with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent or an appropriate substitute was obtained from all patients prior to their inclusion in the study.

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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019

Authors and Affiliations

  1. 1.Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
  2. 2.Department of Clinical Trial Planning and Management, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan

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