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Comparative Study
. 2020 Jan-Dec:19:1533033820973281.
doi: 10.1177/1533033820973281.

A Comparison of the Short-Term Clinical Effects Between Totally Laparoscopic Radical Gastrectomy With Modified Roux-en-Y Anastomosis and Laparoscopic-Assisted Radical Gastrectomy With Roux-en-Y Anastomosis

Guangsheng Zhu  1 , Junjie Hu  1 , Li Lu  1 , Shaozhong Wei  1 , Zhiguo Xiong  1
Affiliations
Comparative Study

A Comparison of the Short-Term Clinical Effects Between Totally Laparoscopic Radical Gastrectomy With Modified Roux-en-Y Anastomosis and Laparoscopic-Assisted Radical Gastrectomy With Roux-en-Y Anastomosis

Guangsheng Zhu et al. Technol Cancer Res Treat. 2020 Jan-Dec.

Abstract

Objective: To compare the short-term clinical effects between totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis, and laparoscopic-assisted radical gastrectomy with Roux-en-Y anastomosis; to explore the safety, feasibility and short-term effect of totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis.

Methods: Data of 75 patients who underwent totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis, and 95 patients who underwent laparoscopic-assisted radical gastrectomy with Roux-en-Y anastomosis by the same surgical team were analyzed. During the modified Roux-en-Y anastomosis, the stomach separation and regional lymph node dissection were completed under a laparoscope; the specimen was placed in a bag; gastrojejunostomy was completed; the subumbilicus hole was enlarged to 3 cm; the specimen was taken out; then, the proximal and distal ends of the small intestine were moved outside of the abdominal wall to complete the small intestine-small intestine end-to-side anastomosis.

Results: All 170 operations were successful. The differences in the time of anastomosis and the number of dissected lymph nodes between the 2 groups were not statistically significant (P > 0.05), but in the totally-MA group the amount of bleeding and the length of incision significantly decreased (P < 0.05). The recovery time as measured by breathing unassisted, drinking fluids and getting out of bed was significantly shorter than those in the laparoscopic-assisted group (P < 0.05), and the pain score 1 day after surgery was significantly lower than that of the laparoscopic-assisted group (P < 0.05). One case of duodenal stump leakage and 1 case of esophagojejunostomy leakage were found in the laparoscopic-assisted group. In the totally-MA group, there were no complications such as anastomotic leakage, anastomotic stenosis or anastomotic bleeding, but 2 patients with double primary carcinoma underwent joint radical resection.

Conclusion: Compared with laparoscopic-assisted surgery, totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis has the advantages of being safer and less traumatic, with associated reductions in bleeding and pain.

Keywords: clinical efficacy; laparoscopic-assisted radical gastrectomy; modified roux-en-y anastomosis; roux-en-y anastomosis; totally laparoscopic radical gastrectomy.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Trocar location diagram.
Figure 2.
Figure 2.
Modified Rouxen-Y anastomosis after distal gastrectomy. A, Amputation of duodenum, (B) Amputation of the stomach, (C) Amputation of jejunum. D, Incising the distal jejunum. E, Incising the greater curvature of the stomach. F, Closing the remnant stomach and jejunum. G, Closing the common opening of the stomach and jejunum. H, Anastomosis between the stomach and jejunum. I, Suturing marked proximal jejunum and small intestine.
Figure 3.
Figure 3.
Modified Rouxen-Y anastomosis after total gastrectomy. A, Amputation of duodenum. B, Incising marked wall of esophagus. C, Incising jejunum. D, Closing the esophagus and jejunum. E, Closing the common opening of the esophagus and jejunum. F, Anastomosis between the esophagus and jejunum. G, Suturing marked proximal jejunum and small intestine.
Figure 4.
Figure 4.
Completing small intestine-small intestine end-to-side anastomosis out of the body.
Figure 5.
Figure 5.
Incision after the operation.
See this image and copyright information in PMC

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