Total laparoscopic distal gastrectomy for gastric cancer: uncut Roux-en-Y anastomosis versus Billroth Ⅱ anastomosis / 中华全科医师杂志

ABSTRACT

Objective To compare the advantages and disadvantages between Uncut Roux-en-Y anastomosis and Billroth Ⅱ anastomosis in total laparoscopic distal gastrectomy (TLDG) for gastric cancer.Methods The clinical data of 132 patients with distal gastric cancer,who underwent TLDG with Uncut Roux-en-Y anastomosis or Billroth Ⅱ anastomosis in the Affiliated Hospital,Medical School of Ningbo University from February 2015 to December 2017,were retrospectively analyzed.There were 52 patients receiving TLDG with uncut Roux-en-Y anastomosis (RA group) and 80 patients receiving TLDG with Billroth Ⅱ anastomosis (BA group).Results Compared with BA group,the RA group had a longer operation time [(240.6±49.6)min vs.(202.2±36.4)min,F=2.356,P =0.000]and anastomosis time[(49.1 ±5.9)min vs.(47.3±4.2)min,F=4.45,P =0.043],more intraoperative blood loss[(128.9 ± 130.0)ml vs.(79.2 ± 62.5)ml,F=5.66,P =0.004];and short times to first flatus[(2.7±0.8)d vs.(3.0±0.6)d,F=6.61,P =0.031],for liquid diet[(3.7±0.8)d vs.(4.0 ± 0.6)d,F=7.35,P=0.022] and semifluid diet[(4.7 ± 0.8)d vs.(5.0 ± 0.6)d,F=6.43,P=0.013].No perioperative death occurred in two groups;there were no significant differences in length of postoperative hospital stay [(9.4±4.2)d vs.(l0.9±6.4)d,F=0.83,P =0.117]and the incidence of postoperative complication [5.8％(3/52) vs.8.8％(7/80),x2=0.40,P =0.527)].Compared to BA group,alkaline reflex gastritis rate [3.8％(2/52) vs.52.5％(42/80),x2=40.04,P =0.000]and marginal ulcer rate were lower[0(0/52) vs.11.3％(9/80),x2=6.28,P =0.012].There was no significant difference in dumping syndrome rate[0(0/52) vs.3.8％(3/80),x2=0.20,P=0.158] between two groups.Conclusion Uncut Roux-en-Y anastomosis can prevent alkaline reflex gastritis,marginal ulcer and Roux-en-Y stasis syndrome,it may be the preferable technique for reconstruction after total laparoscopic distal gastrectomy.