Uncut Roux-en-Y Reconstruction after Laparoscopic Distal Gastrectomy Can Be a Favorable Method in Terms of Gastritis, Bile Reflux, and Gastric Residue

Abstract

Purpose: Laparoscopic distal gastrectomy (LDG) is a well-established procedure for the treatment of early gastric cancer. Several reconstruction methods can be adopted after LDG according to tumor characteristics and surgeon preference. This study aimed to compare the remnant gastric functions after different reconstructions.

Materials and methods: In total, 221 patients who underwent LDG between March 2005 and October 2013 were reviewed retrospectively. The patients were classified into four groups based on the reconstructive procedure: Billroth I (BI) anastomosis, Billroth II (BII) with Braun anastomosis, Roux-en-Y (RY) reconstruction, or uncut RY reconstruction. Patient demographics, surgical outcomes, and postoperative endoscopic findings were reviewed and compared among groups.

Results: Endoscopic evaluations at 11.8±3.8 months postoperatively showed less frequent gastritis and bile reflux in the remnant stomach in the RY group compared to the BI and BII groups. There was no significant difference in the gastric residue among the BI, BII, and RY groups. The incidence of gastritis and bile reflux in the uncut RY group was similar to that in the RY group, while residual gastric content in the uncut RY group was significantly smaller and less frequently observed than that in the RY group (5.8% versus 35.3%, P=0.010).

Conclusions: RY and uncut RY reconstructions are equally superior to BI and BII with Braun anastomoses in terms of gastritis and bile reflux in the remnant stomach. Furthermore, uncut RY reconstruction showed improved stasis compared to conventional RY gastrojejunostomy. Uncut RY reconstruction can be a favorable reconstructive procedure after LDG.

Keywords: Anastomosis, Roux-en-Y; Bile reflux; Gastrectomy; Reconstructive surgical procedures; Stomach neoplasms.

Fig. 1

Systemic inflammatory response after surgery according to the reconstructive procedures. BI = Billroth I gastroduodenostomy; BII = Billroth II gastrojejunostomy; RY = Roux-en-Y reconstruction. ^*P<0.05; by one-way analysis of variance.

Fig. 2

Comparison of endoscopic findings after different reconstruction methods following laparoscopic distal gastrectomy: residual food (A), degree of gastritis (B), and bile reflux (C). BI = Billroth I gastroduodenostomy; BII = Billroth II gastrojejunostomy; RY = Roux-en-Y reconstruction. ^*P<0.05; ^**P<0.005 by Pearson's chi-square test or Fisher's exact test.