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Resumen La colangiopancreatografía retrógrada endoscópica (CPRE) es un procedimiento útil en el manejo de enfermedades biliopancreáticas. Los pacientes con alteración anatómica del tracto gastrointestinal representan un desafío técnico por múltiples razones. Con técnicas como la enteroscopia de doble balón (EDB) es posible realizar una CPRE en estos pacientes. El caso que se presenta es el primero de este tipo publicado en Colombia sobre una paciente con gastrectomía total con reconstrucción en Y-de-Roux y coledocolitiasis.
Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable procedure in managing biliopancreatic diseases. Patients with anatomical alteration of the gastrointestinal tract represent a technical challenge for multiple reasons. With techniques such as double-balloon enteroscopy (DBE), it is possible to perform ERCP in these patients. The case was first published in Colombia on a female patient with total gastrectomy with Roux-en-Y reconstruction and choledocholithiasis.
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Objective: To compare clinical efficacy between laparoscopic radical proximal gastrectomy with double-tract reconstruction (LPG-DTR) and laparoscopic radical total gastrectomy with Roux-en-Y reconstruction (LTG-RY) in patients with early upper gastric cancer, and to provide a reference for the selection of surgical methods in early upper gastric cancer. Methods: A retrospective cohort study method was carried out. Clinical data of 80 patients with early upper gastric cancer who underwent LPG-DTR or LTG-RY by the same surgical team at the Department of General Surgery, the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to January 2021 were retrospectively analyzed. Patients were divided into the DTR group (32 cases) and R-Y group (48 cases) according to surgical procedures and digestive tract reconstruction methods. Surgical and pathological characteristics, postoperative complications (short-term complications within 30 days after surgery and long-term complications after postoperative 30 days), survival time and nutritinal status were compared between the two groups. For nutritional status, reduction rate was used to represent the changes in total protein, albumin, total cholesterol, body mass, hemoglobin and vitamin B12 levels at postoperative 1-year and 2-year. Non-normally distributed continuous data were presented as median (interquartile range), and the Mann-Whitney U test was used for comparison between groups. The χ(2) test or Fisher's exact test was used for comparison of data between groups. The Mann-Whitney U test was used to compare the ranked data between groups. The survival rate was calculated by Kaplan-Meier method categorical, and compared by using the log-rank test. Results: There were no statistically significant differences in baseline data betweeen the two groups, except that patients in the R-Y group were oldere and had larger tumor. Patients of both groups successfully completed the operation without conversion to laparotomy, combined organ resection, or perioperative death. There were no significant differences in the distance from proximal resection margin to superior margin of tumor, postoperative hospital stay, time to flatus and food-taking, hospitalization cost, short- and long-term complications between the two groups (all P>0.05). Compared with the R-Y group, the DTR group had shorter distal margins [(3.2±0.5) cm vs. (11.7±2.0) cm, t=-23.033, P<0.001], longer surgery time [232.5 (63.7) minutes vs. 185.0 (63.0) minutes, Z=-3.238, P=0.001], longer anastomosis time [62.5 (17.5) minutes vs. 40.0 (10.0) minutes, Z=-6.321, P<0.001], less intraoperative blood loss [(138.1±51.6) ml vs. (184.3±62.1) ml, t=-3.477, P=0.001], with significant differences (all P<0.05). The median follow-up of the whole group was 18 months, and the 2-year cancer-specific survival rate was 97.5%, with 100% in the DTR group and 95.8% in the R-Y group (P=0.373). Compared with R-Y group at postoperative 1 year, the reduction rate of weight, hemoglobin and vitamin B12 were lower in DTR group with significant differences (all P<0.05); at postoperative 2-year, the reduction rate of vitamin B12 was still lower with significant differences (P<0.001), but the reduction rates of total protein, albumin, total cholesterol, body weight and hemoglobin were similar between the two groups (all P>0.05). Conclusions: LPG-DTR is safe and feasible in the treatment of early upper gastric cancer. The short-term postoperative nutritional status and long-term vitamin B12 levels of patients undergoing LPG-DTR are superior to those undergoing LTG-RY.
Subject(s)
Humans , Albumins , Anastomosis, Roux-en-Y/adverse effects , Cholesterol , Gastrectomy/methods , Hemoglobins , Laparoscopy/methods , Postoperative Complications/etiology , Retrospective Studies , Stomach Neoplasms/pathology , Treatment Outcome , Vitamin B 12ABSTRACT
Objective To evaluate the feasibility and safety of endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y reconstruction. Methods 22 cases underwent ERCP after Roux-en-Y reconstruction from January 2015 to January 2017 were collected, the operating time, success rate of endoscopy and treatment, related complications were analyzed. Results ERCP was performed in 22 cases about Roux-en-Y reconstruction of digestive tract, the mean insertion and cannulation time was 74.1 and 22.5 minutes; the overall success rate was 81.8% (18/22) and 77.2% (17/22), and no major complications occurred. Conclusions ERCP can be used as a safe and effective method for the diagnosis and treatment on the Roux-en-Y reconstruction of digestive tract.
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Objective To study the effectiveness and safety comparing Roux-en-Y versus Billroth Ⅱ alimentary canal reconstruction after pancreaticoduodenectomy (PD).Methods A computer search was conducted on PubMed,Embase,Web of Science,Science Direct,Springer Link,Cochrane Center,CBM,CNKI,Wan Fang and VIP databases before September 2017 for all RCT and CCT articles on Roux-en-Y versus Billroth Ⅱ reconstruction after PD.The quality of the included trials was studied by assessing the inclusive and exclusive criteria (the PRISMA statement) by 2 researchers independently.The data were extracted and analyzed using the RevManS.3 software.Results 9 articles (3 RCTs,6 CCTs) which involved 1 599 patients (563 Roux-en-Y patients,1 036 Billroth Ⅱ patients) were studied.Meta analysis revealed that Billroth Ⅱ patients had a lower postoperative delayed gastric emptying (DGE,grades B,C) rate (OR =3.76,95％ CI:1.32 ～ 10.68,P ＜ 0.05) and a shorter operation time (WMD =32.75,95％ CI:8.17 ～57.33,P ＜ 0.05) than Roux-en-Y patients.There were no significant differences in the rates of postoperative delayed gastric emptying (grades A,B,C),pancreatic fistula,bile leak,postoperative hemorrhage,reoperation,postoperative complications and the duration of postoperative stay (P ＞ 0.05).Conclusions The incidence of DGE (grades B,C) after PD was lower after Billroth Ⅱ than that of Roux-en-Y reconstruction.Large prospective randomized controlled trials are needed to confirm the findings of this meta-analysis.
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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).
Subject(s)
Humans , Bile , Bile Reflux , Gastrectomy , Gastric Stump , Gastritis , Hand , Methods , Prospective Studies , Stomach NeoplasmsABSTRACT
Endoscopic retrograde cholangiopancreatography (ERCP) in post-gastrectomy patients with Billroth II (BII) reconstruction and Roux-en-Y (RY) reconstruction presents a challenge to therapeutic endoscopists. Major difficulties, including intubation to the ampulla of Vater, selective cannulation, and ampullary intervention, must be overcome in these patients. Recent data have shown that device-assisted ERCP allows for high success rates in these patients because various devices are useful for overcoming major difficulties. Therefore, good knowledge of postoperative anatomy and various devices is mandatory before performing ERCP procedures for post-gastrectomy patients.