Uncut Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy with specimen extraction through natural orifice: A report of 7 cases

Abstract

Objective To investigate the safety, feasibility and short term outcome of totally laparoscopic uncut Roux-en-Y anastomosis in the distal gastrectomy for gastric cancer with specimen extraction through natural orifice. Methods The clinical data of seven cases of total laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D2 dissection for gastric cancer from January 2017 to May 2017 in Linzi District Hospital were analyzed retrospectively. The operation time, intraoperative bleeding volume, number of lymph nodes resected, incidence of complication, length of hospital stay and follow-up were observed. Results All of them underwent total laparoscopic uncut Roux-en-Y anastomosis. All the procedures were performed successfully. There were neither conversions to open surgery, nor intraoperative complications in all seven cases. The median time of the operation was 280 (260~320) min and the median time of anastomosis was 45 (35~55) min. The blood loss was 90 (30~120) ml. The time to flatus and length of postoperative hospital stay were 2 (1~3) d and 8 (7~13) d, respectively. No major postoperative complication occurred, such as anastomotic leak, Roux stasis syndrome and rectal stenosis. Conclusion The totally laparoscopic uncut Roux-en-Y anastomosis in distal gastrectomy with lymph node dissection for gastric cancer is safe and feasible, with a very low rate of reflux gastritis; laparoscopic distal gastrectomy with specimen extraction through natural orifice has the less trauma, lighter postoperative pain, and the operation time is not significantly prolonged. Key words: Gastric neoplasms; Laparoscopy; Gastrectomy; Uncut Roux-en-Y anastomosis; Natural orifice specimen extraction surgery (NOSES)