Total laparoscopic distal gastrectomy for gastric cancer: uncut Roux-en-Y anastomosis versus Billroth II anastomosis

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. (10.9±6.4) d, F=0.83, P=0.117]and the incidence of postoperative complication[5.8%(3/52) vs. 8.8%(7/80), χ2=0.40, P=0.527)]. Compared to BA group,alkaline reflex gastritis rate [3.8%(2/52) vs. 52.5%(42/80), χ2=40.04, P=0.000]and marginal ulcer rate were lower[0(0/52) vs. 11.3%(9/80), χ2=6.28,P=0.012]. There was no significant difference in dumping syndrome rate[0(0/52) vs. 3.8%(3/80), χ2=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. Key words: Stomach neoplasms; Carcinoma; Laparoscopy; Gastrectomy; Anastomosis, Roux-en-Y