J Gastric Cancer.  2017 Sep;17(3):255-266. 10.5230/jgc.2017.17.e32.

A Novel Roux-en-Y Reconstruction Involving the Use of Two Circular Staplers after Distal Subtotal Gastrectomy for Gastric Cancer

• Hur H
• Ahn CW
• Byun CS
• Shin HJ
• Kim YB
• Son SY
• Han SU

• KMID: 2389830
• DOI: http://doi.org/10.5230/jgc.2017.17.e32

Abstract

PURPOSE
Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several advantages, such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This prospective randomized clinical trial aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers by comparing this novel method to Billroth-I (B-I) reconstruction.
MATERIALS AND METHODS
A total of 118 patients were randomly allocated into the R-Y (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using two circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach evaluated using endoscopic and histological findings at 6 months after surgery.
RESULTS
No significant differences in clinicopathological findings were observed between the 2 groups. Although anastomosis time was significantly longer for the patients of the R-Y group (P<0.001), no difference was detected between the 2 groups in terms of the total surgery duration (P=0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P<0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P=0.026).
CONCLUSIONS
The results of this randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure. This clinical trial study was registered at www.ClinicalTrials.gov (registration No. NCT01142271).

Keyword

Gastric cancer; Distal gastrectomy; Roux en Y reconstruction; Circular stapler

MeSH Terms

Bile
Bile Reflux
Gastrectomy*
Gastric Stump
Gastritis
Hand
Humans
Methods
Prospective Studies
Stomach Neoplasms*

Figure

• 

  Fig. 1 Surgical procedure for R-Y reconstruction included (A) division of the proximal jejunum and mesentery, (B) insertion of a 21-mm anvil into the resected distal jejunum, (C) insertion of the stapler body into the resected proximal jejunum, (D) anastomosis of jejunojejunostomy using a 21-mm circular stapler, (E) insertion of a 29-mm anvil into the proximal jejunum, and (F) anastomosis of the gastrojejunostomy by using the Tonado method with a 29-mm circular stapler. R-Y = Roux-en-Y.

• 

  Fig. 2 Histological findings of biopsied tissues in the remnant stomach. (A) The tissue received a score of 0 on evaluation, as per the grading system suggested by Dixon et al. [14]. (B) The tissue received a score of 12.

• 

  Fig. 3 Study design according to the CONSORT diagram. CONSORT = Consolidated Standards of Reporting Trials; B-I = Billroth-I; B-II = Billroth-II; R-Y = Roux-en-Y.

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