J Gastric Cancer.  2011 Dec;11(4):219-224.

Efficacy of Roux-en-Y Reconstruction Using Two Circular Staplers after Subtotal Gastrectomy: Results from a Pilot Study Comparing with Billroth-I Reconstruction

• Kim TG
• Hur H
• Ahn CW
• Xuan Y
• Cho YK
• Han SU

Abstract

PURPOSE
The Roux en Y method has rarely been performed due to longer operation time and high risk of complication, despite several merits including prevention of bile reflux. We conducted a retrospective review of the result of Roux en Y reconstruction using two circular staplers after subtotal gastrectomy.
MATERIALS AND METHODS
From December 2008 to May 2009, a total of 26 patients underwent Roux en Y reconstruction using two circular staplers after subtotal gastrectomy, and seventy-two patients underwent Billroth-I reconstruction. Roux en Y anastomosis was performed using two circular staplers without hand sewing anastomosis. We compared clinicopathologic features and surgical outcomes between the two groups. All patients underwent gastrofiberscopy between six and twelve months after surgery to compare the bile reflux.
RESULTS
No significant differences in clinicopathologic findings were observed between the two groups, except for the rate of minimal invasive surgery (P=0.004) and cancer stage (P=0.002). No differences in the rate of morbidity (P=0.353) and admission duration (P=0.391) were observed between the two groups. Gastrofiberscopic findings showed a significant reduction of bile reflux in the remnant stomach in the Roux en Y group (P=0.019).
CONCLUSIONS
When compared with Billroth-I reconstruction, Roux en Y reconstruction using the double stapler technique was found to reduce bile reflux in the remnant stomach without increasing postoperative morbidity. Based on these results, we planned to begin a randomized controlled clinical trial for comparison of Roux en Y reconstruction using this method with Billroth-I anastomosis.

Keyword

Stomach neoplasms; Gastrectomy; Reconstructive surgical procedure

MeSH Terms

Anastomosis, Roux-en-Y
Bile
Bile Reflux
Gastrectomy
Gastric Stump
Hand
Humans
Pilot Projects
Reconstructive Surgical Procedures
Retrospective Studies
Stomach Neoplasms

Figure

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  Fig. 1 Surgical procedure for Roux en Y reconstruction. (A) Division of the proximal jejunum. (B) Insertion of the 21 mm envil into the distal end of the divided jejunum and introduction of the body of a 21 mm stapler into 30 to 40 cm distal. (C) Insertion of another envil into the distal end of the resected jejunum. (D) Stapling for gastrojejunostomy.

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  Fig. 2 Completion of Roux en Y reconstruction using two circular staplers after distal gastrectomy.

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