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Randomized Controlled Trial
. 2023 Jun;27(6):1098-1105.
doi: 10.1007/s11605-023-05644-6. Epub 2023 Mar 14.

Tranditional Roux-en-Y vs Uncut Roux-en-Y in Laparoscopic Distal Gastrectomy: a Randomized Controlled Study

Huahao Xie #  1 , Feng Wu #  1   2 , Chenshen Huang #  1   3 , Quanning Chen #  1 , Zhizhan Ni  1 , Song Wang  1 , Bujun Ge  4 , Liming Liu  5   6 , Qi Huang  7
Affiliations
Randomized Controlled Trial

Tranditional Roux-en-Y vs Uncut Roux-en-Y in Laparoscopic Distal Gastrectomy: a Randomized Controlled Study

Huahao Xie et al. J Gastrointest Surg. 2023 Jun.

Abstract

Background: Traditional Roux-en-Y may cause Roux-en-Y stasis syndrome (RSS), and Uncut Roux-en-Y was proposed to solve this problem. However, because afferent loop recanalization may occur after surgery, its clinical application remains controversial. The purpose of this study was to compare the long-term outcomes of these two gastrointestinal reconstruction methods.

Methods: A total of 108 patients who received laparoscopic-assisted distal gastrectomy (LADG) were enrolled; 57 were randomly divided into the Uncut Roux-en-Y (URY) group, and 51 were divided into the Roux-en-Y (RY) group. Patients were followed up for 1 year to evaluate variables, including the following: (1) Assessments for RSS; (2) Preoperative and postoperative Gastrointestinal Symptom Rating Scale (GSRS) scores; (3) Postoperative gastroscopy to assess the occurrence of reflux esophagitis (Los Angeles classification), residual gastritis and bile reflux 1 year after surgery; and (4) Upper gastrointestinal radiography to evaluate whether recanalization occurred in patients in the URY group after surgery.

Results: At 1 year after surgery, a total of 42 patients (73.7%) developed afferent loop recanalization. The incidence of RSS was not different between the two groups (OR, 1.301 [95% CI, 0.482 to 3.509]; P = 0.603P = 0.603). The GSRS score was higher in the URY group (P < 0.001). Postoperative gastroscopy showed that the incidence of bile reflux (P < 0.001) and the grade of residual gastritis (P < 0.001) were significantly higher in the URY group, but the grade of reflux esophagitis was not significantly different (P = 0.447, [95% CI, 0.437 to 0.457]P = 0.397).

Conclusions: Compared with traditional Roux-en-Y anastomosis, due to the high recanalization rate, the URY group developed more severe gastrointestinal symptoms, the incidence of bile reflux and the grade of residual gastritis increased and the incidence of postoperative RSS was not reduced.

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Conflict of interest statement

There are no financial conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Consort diagram for the study
Fig. 2
Fig. 2
Uncut Roux-en-Y anastomosis procedure. (a) Closed afferent limb in vitro (6 rows of nails). (b) Afferent limb jejunum closed with a linear stapler. (c) Afferent limb (6 rows of nails, black arrow)
Fig. 3
Fig. 3
Changes in the recanalization rate after Uncut Roux-en-Y anastomosis
Fig. 4
Fig. 4
Upper gastrointestinal radiography after Uncut Roux-en-Y anastomosis. Upper gastrointestinal radiography showing the closure of the afferent limb (black arrows) 6 months after the operation (a) and recanalization (black arrow) 9 months after the operation (b). In another case, upper gastrointestinal radiography showing the closure of the afferent limb (black arrow) 9 months after the operation (c) and recanalization (black arrow) 12 months after the operation (d)
Fig. 5
Fig. 5
Gastroscopy in the URY group at 1 year after surgery. (a) Endoscopy showing esophageal mucosal hyperemia and edema. (b) Endoscopy showing residual gastric hyperemia and edema with ulcers and bile reflux seen around. (c) and (d) Both showing recanalization of the afferent limb, bile reflux, yellow‒green mucus, and anastomotic edema
See this image and copyright information in PMC

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