Isoperistaltic versus antiperistaltic uncut Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a propensity score matched analysis

Cui, Hangtian; Huabing, Huang; Luo, Tianhang; Yin, Xinmin; Fang, Guoen

doi:10.1186/s12893-020-00936-z

Cited by 5 publications

(1 citation statement)

References 22 publications

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“…According to a previous study, closing the afferent loop jejunum may not result in permanent healing between the mucosa and the mucosa, which is the main reason for the recanalization of the bowel. [29][30][31] This finding indicates that the linear stapler is not complete enough to close the afferent limb jejunum and needs to be further improved. Some scholars have proposed different methods of closing the afferent loop, and it has been reported that ligation with a 7-gauge silk thread can effectively reduce the recanalization rate.…”

Section: Discussionmentioning

confidence: 98%

Tranditional Roux-en-Y vs Uncut Roux-en-Y in Laparoscopic Distal Gastrectomy: a Randomized Controlled Study

Xie

Huang

et al. 2023

Journal of Gastrointestinal Surgery

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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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Section: Discussionmentioning

confidence: 98%

Tranditional Roux-en-Y vs Uncut Roux-en-Y in Laparoscopic Distal Gastrectomy: a Randomized Controlled Study

Xie

Huang

et al. 2023

Journal of Gastrointestinal Surgery

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Short‐term outcomes after totally laparoscopic total gastrectomy with esophagojejunostomy constructed by π‐shaped method versus overlap method

Wang

Liu

Shan

et al. 2021

Journal of Surgical Oncology

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Background: Regarding the overlap anastomosis and recently introduced π-shaped anastomosis, there is no consensus on which intracorporeal esophagojejunostomy (EJS) methods are preferred using linear stapler in totally laparoscopic total gastrectomy (TLTG). This study aims to evaluate the short-term outcomes using two methods.Methods: Patients with upper gastric cancer underwent TLTG with either π-shaped (n = 48) or the modified overlap method using knotless barbed sutures (MOBS) (n = 37) were included in our study. Intraoperative and perioperative outcomes were compared.Results: All patients achieved R0 resection margin. The overall esophagojejunal (E-J)related complications rate was 7.06%. There was no significant difference between the two groups in terms of postoperative complications, margin distance, numbers of lymph nodes (LNs), length of stay. In the π-shaped group, anastomosis time (19.61 ± 7.17 min vs. 27.09 ± 3.59 min, p < 0.001) was significantly lower. The consumable costs for surgery were similar (44 507.74¥ [42 933.03-46 937.29] vs. 43 718.36¥ [42 743.25-47 256.06], p = 0.825). The first defection time was significantly longer in π-shaped group (131.00 h [93.75-171.25] vs. 100.00 h [85.00-120.00], p = 0.026), whereas the other postoperative recovery parameters were similar. No mortality was observed.Conclusions: Both methods showed similar short-term postoperative outcomes. The π-shaped technique was faster than the MOBS method without significantly increasing the supplies costs. Large prospective studies are warranted.

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Short-term outcomes of sleeve gastrectomy plus uncut jejunojejunal bypass (SG–uncut JJB) in patients with obesity: a preliminary prospective cohort study

Zhang

Zhai

Cao

et al. 2023

Langenbecks Arch Surg

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Isoperistaltic versus antiperistaltic uncut Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a propensity score matched analysis

Cited by 5 publications

References 22 publications

Tranditional Roux-en-Y vs Uncut Roux-en-Y in Laparoscopic Distal Gastrectomy: a Randomized Controlled Study

Tranditional Roux-en-Y vs Uncut Roux-en-Y in Laparoscopic Distal Gastrectomy: a Randomized Controlled Study

Short‐term outcomes after totally laparoscopic total gastrectomy with esophagojejunostomy constructed by π‐shaped method versus overlap method

Short-term outcomes of sleeve gastrectomy plus uncut jejunojejunal bypass (SG–uncut JJB) in patients with obesity: a preliminary prospective cohort study

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