Comparison of the Clinical Outcomes Between Isoperistaltic and Antiperistaltic Anastomoses After Laparoscopic Distal Gastrectomy for Patients With Gastric Cancer

Abstract

Background: No consensus exists regarding the superiority of either of the two types of gastrointestinal anastomosis, which are isoperistaltic and antiperistaltic. This study aimed to compare the clinical outcomes between isoperistaltic and antiperistaltic anastomoses after total laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer. Methods: We retrospectively reviewed the medical records of patients with gastric cancer who underwent TLDG with Billroth II anastomosis between January 2014 and December 2018. The patients were divided into two groups according to the peristaltic direction of gastrointestinal anastomosis after TLDG. One group underwent isoperistaltic anastomosis (Iso group), and the other underwent antiperistaltic anastomosis (Anti group). Clinical outcomes were compared between the groups. Results: Of the 148 patients who underwent TLDG with Billroth II anastomosis, 124 were included in the Iso group and 24 were included in the Anti group. The Anti and Iso groups showed no significant difference with regard to the incidence of internal hernia (0.0 vs. 6.5%, respectively; p = 0.355). The incidence of bile reflux was more frequent in the Iso group than in the Anti group (p = 0.010), but food stasis was more common in the Anti group than in the Iso group (p = 0.006). Conclusion: In gastric cancer patients who underwent TLDG in which postoperative adhesion was minimized, antiperistaltic anastomosis may have created a physiologic barrier in gastrointestinal continuity. However, a large-scale study is necessary to validate the relationship between the digestive stream and the peristaltic direction.

Reappraisal of optimal reconstruction after distal gastrectomy – a study based on KLASS-07 database

“…Similarly, the antiperistaltic direction in the ileocolic anastomosis may behave like a functional pseudo-valve, reducing ileocecal reflux. The theory of a physiologic barrier in antiperistaltic GJ is consistent with the mechanism of ‘functional pseudo-valvular mechanism for colonic anastomosis’ 33 , 34 . In the current study, the impact of the peristaltic direction on patient outcomes could not be analyzed because the surgeons unified the direction of the GJ in an isoperistaltic manner prior to patient enrollment.…”

“…Third, the severity of bile reflux varies depending on the direction of the GJ. Interestingly, the incidence of bile reflux after LDG with BII was lower in the antiperistaltic group than in the isoperistaltic group 33 . This can be explained by the mechanism of a physiological barrier in which food stasis arising from antiperistaltic anastomosis acts as a barrier against bile reflux.…”

Short-Term and Long-Term Outcomes and Quality of Life Comparison of Total Laparoscopic Distal Gastrectomy Reconstruction: Roux-en-Y versus Billroth II+Braun

“…Motoyama K and An JY controlled the length of the "R-Y limb" to 25-30 cm, and none experienced RSS postoperatively [31,32]. Additionally, our study utilized isoperistaltic Roux-en-Y anastomosis, which aligns more closely with human physiology and facilitates food emptying compared to antiperistaltic anastomosis [33]. Only one patient experienced RSS (1.8%), which was signi cantly lower than that in previous reports.…”

Feasibility and preliminary experience of single-incision plus one-port laparoscopic total gastrectomy with Overlap esophagojejunostomy for gastric cancer: A study of 10 cases

“…Once intraoperative freezing results in a positive esophageal margin, the surgeon needs to enlarge the resection of the esophagus under SITG + 1 and re-perform esophagojejunal anastomosis at a higher position, which can be challenging. Additionally, an esophagojejunal π-shaped anastomosis may lead to an antiperistalsis at the junction of the esophagus and jejunum, which is not conducive to esophageal emptying ( 19 ).…”