Outcomes of laparoscopic subtotal colectomy with cecorectal anastomosis for slow-transit constipation: a single center retrospective study.

PURPOSE: To study the safety and efficacy of laparoscopic subtotal colectomy (LASC) with cecorectal anastomosis for slow-transit constipation (STC). METHODS: This study was a retrospective review of all patients undergoing LASC with cecorectal anastomosis for STC between March 2010 and May 2017. The main variables included the operative time, blood loss, length of postoperative hospital stay, complications, and long-term outcomes. RESULTS: In this analysis, 56 patients were included. There were 17 males and 39 females aged between 34 and 80 years old. The mean operative time was 208 ± 21 min, and the mean perioperative blood loss was 116 ± 48 mL. The mean postoperative hospital stay was 7.7 ± 3.5 days, and the incidence of perioperative complications was 19.6%, with no mortality. One patient required reoperation because of intra-abdominal bleeding. During the follow-up period, 26.8% of patients suffered from chronic pain and bloating, with no recurrence of STC. The causes of these symptoms included small bowel obstruction (7.1%), slow transit (10.7%), anastomotic stenosis (5.4%) and gastroptosis (3.6%). Postoperatively, after 12 months, the frequency of defecation was 2-4 times per day. Patients with follow-up of at least 60 months, the mean frequency of defecation was 0.9 ± 0.5 times per day. The percentage of satisfaction was 82.1%. CONCLUSION: LASC with cecorectal anastomosis is a safe and effective surgical approach for STC, with the majority of patients being satisfied with the outcome of surgery.

Randomized controlled trial of uncut Roux-en-Y vs Billroth II reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis?

AIM: To identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and Billroth II reconstruction. METHODS: A total of 158 patients who underwent laparoscopy-assisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University (Changchun, China) between February 2015 and February 2016 were randomized into two groups: uncut Roux-en-Y (group U) and Billroth II group (group B). Postoperative complications and relevant clinical data were compared between the two groups. RESULTS: According to the randomization table, each group included 79 patients. There was no significant difference in postoperative complications between groups U and B (7.6% vs 10.1%, P = 0.576). During the postoperative period, group U stomach pH values were lower than 7 and group B pH values were higher than 7. After 1 year of follow-up, group B presented a higher incidence of biliary reflux and alkaline gastritis. However, histopathology did not show a significant difference in gastritis diagnosis (P = 0.278), and the amount of residual food and gain of weight between the groups were also not significantly different. At 3 mo there was no evidence of partial recanalization of uncut staple line, but at 1 year the incidence was 13%. CONCLUSION: Compared with Billroth II reconstruction, uncut Roux-en-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn. Despite the incidence of recanalization, uncut Roux-en-Y should be widely applied.