In recent years, with the standardization and promotion of laparoscopic techniques, the use of laparoscopic radical total gastrectomy is increasing. The main difficult points of this technique focus on digestive tract reconstruction after total gastrectomy. Esophagojejunal Roux-en-Y anastomosis is the first choice in laparoscopic reconstruction. There are two main methods for totally laparoscopic total gastrectomy (TLTG). One is esophagojejunal end-to-side anastomosis using circular stapler, and the other is esophagojejunal side-to-side anastomosis using linear staplers. TLTG has its advantages in digestive tract reconstruction including better visualization high safety and less trauma, which makes it a safe, convenient and effective method for reconstruction.
Anastomosis, Roux-en-Y ; methods ; Gastrectomy ; methods ; Humans ; Laparoscopy ; methods

Methods of digestive tract reconstruction after distal gastrectomy include Billroth I, Billroth II and Roux-en-Y. Each of them has advantages and disadvantages respectively. Alkaline reflux gastritis (ARG) is one of the complications after distal gastrectomy, which is common after Billroth II. In the past 100 years, the ways of digestive tract reconstruction have been continuously improved and developed to prevent the occurrence of alkaline reflux gastritis, and Roux-en-Y is one of them. Still, there is a high incidence of Roux stasis syndrome resulting from Roux-en-Y, with impact on quality of life. Therefore, the appropriate reconstruction is needed urgently. Braun anastomosis was proposed in 1892 to lower the incidence of afferent syndrome. Because of its effect of diverting some alkaline digestive juice, it was applied to pancreaticoduodenectomy and distal gastrectomy. Some studies have proved its effect of diverting some alkaline digestive juice, but the diverted quantity was rarely shown. Besides, compared with Roux-en-Y, Billroth II with Braun anastomosis is safer and more convenient. Meantime it is likely to have benefits in aspect of preventing anemia and malnutrition. In order to provide evidence to clinical practice, this article summarizes the history and research advance of Billroth II with Braun anastomosis by reviewing previous reports.
Anastomosis, Roux-en-Y ; Anastomosis, Surgical ; Gastrectomy ; methods ; Gastroenterostomy ; methods ; Humans ; Quality of Life ; Stomach Neoplasms ; surgery

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure carrying potential complication such as pancreatitis, hemorrhage, perforation and cholangitis. Most of those complications are mild and usually need a short additional hospitalization periods. Perforation, however, often requires surgical intervention and in this case, the rate of mortality is up to 10%. Prompt diagnosis and proper management are key determinants for successful outcome. For this, endoscopist should be aware of possibility of perforation before procedure especially in high risk patients with altered anatomy such as prior Billroth II or Roux-en-Y anastomosis. After diagnosis of perforation, multidisciplinary approach involving medical, surgical and radiologic interventional subspecialties, is essential. Usually, surgical treatment is needed for type I free wall perforation and medical and endoscopic treatments are recommended for type II-IV perforation. Recently, several anecdotal studies reported successful endoscopic treatment using new devices for type I duodenal wall perforation but it is not warranted that endoscopic treatments can substitute the surgical intervention.
Anastomosis, Roux-en-Y ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Diagnosis ; Gastroenterostomy ; Hemorrhage ; Hospitalization ; Humans ; Mortality ; Pancreatitis

We experienced a case of synchronously occurring multiple leiomyosarcoma in the jejunum and stomach. The presented case was a 75-year-old man with signs of panperitonitis. We performed a subtotal gastrectomy, a segmental resection of the jejunum and a Roux-en-Y anastomosis. Histologic examination of the resected specimen revealed a high-grade leiomyosarcoma having a high-grade mitosis and pleomorphism. Although it showed high malignancy potential, it was less than 5 cm in size. Also, it was a synchronously occurring multiple leiomyosarcoma having a sparing lesion in the duodenum and showed a lymphatic metastasis. In that point of view, it had many unusual aspects.
Aged ; Anastomosis, Roux-en-Y ; Duodenum ; Gastrectomy ; Humans ; Intestine, Small* ; Jejunum ; Leiomyosarcoma* ; Lymphatic Metastasis ; Mitosis ; Stomach*

Several reconstruction techniques are available after gastrectomy. Roux-en-Y reconstruction following distal gastrectomy is the reference in terms of long-term functional and endoscopic outcomes. It is the preferred reconstruction for benign lesions and early gastric cancer. In patients with advanced gastric cancer, BillrothII (reconstruction is an acceptable alternative. After total gastrectomy, Roux-en-Y reconstruction is the simplest solution, with satisfactory functional outcome. Addition of a jejunal reservoir seems to improve long-term outcome after total gastrectomy and could be of benefit to patients with good prognosis. After distal or total gastrectomy, hand-sewn anastomoses should be preferred because of lower costs. Mechanical sutures can facilitate transhiatal esophagojejunostomy. After proximal gastrectomy, esophago-gastric anastomosis is the basic reconstruction method. Gastric remnant is made into gastric tube in the operation. The effect of pyloroplasty remains controversial, and further study is needed to improve the quality of life after operation.
Anastomosis, Roux-en-Y ; methods ; Gastrectomy ; Gastroenterostomy ; methods ; Humans ; Reconstructive Surgical Procedures ; methods ; Stomach Neoplasms ; surgery

Malnutrition and weight loss after total gastrectomy is one of the major concerns of surgeons. In order to improve the nutritional status in these patients, many surgeons have tried to restore the duodenal passage as reconstructive procedure but debates have been continued. So we investigated weight change, postprandial serum secretin response and fecal fat amount to evaluate the esophagojejunoduodenostomy after which the duodenal passage was restored. Total gastrectomized dogs showed significant weight loss and all experimental animals except sham operation died between five and eight weeks after the operation. Serum secretin concentration after esophagojejunoduodenostomy increased significantly from a mean fasting value of 100 +/- 12.5 pg/mL to a mean peak of 142 +/- 22.5 pg/mL at 40 minutes and returned to the fasting level at 120 minutes postprandially. But fasting and postprandial serum secretin concentration in patients following Roux-en Y esophagojejunostomy were fluctuated irregularly. The amount of fecal fat in esophagojejunoduodenostomy was 5.3 +/- 1.2 gm/100 gm stool, which was not different from that of the control group but in Roux-en Y esophagojejunostomy it was 28.1 +/- 4.1 gm/100 gm stool which was much higher than that observed in esophagojejunoduodenostomy and in control group. These results suggest that esophagojejunoduodenostomy is superior to Roux-en Y esophagojejunostomy in respect to pancreatic secretory function and fat absorption.
Anastomosis, Roux-en-Y ; Animal ; *Animal Nutrition ; Dogs ; Duodenostomy ; Esophagostomy ; *Gastrectomy ; Jejunostomy ; Support, Non-U.S. Gov't

There are various types of digestive tract reconstruction techniques after distal gastrectomy. Among them, Billroth I and II are still the predominant option in China at present. In recent years, Roux-en-Y configuration, jejunal interposition, J-pouch interposition (JPI), double-tract reconstruction, pylorus-preserving method, and laparoscopic reconstruction and anastomosis techniques have gained more attention in recent years. Although there is no universal and explicit guideline, the current consensus is that the reconstruction style should be adopted by the principles of digestive tract reconstruction, based on patient's condition, socioeconomic status and surgeon's experience.
Anastomosis, Roux-en-Y ; Digestive System Surgical Procedures ; methods ; Gastrectomy ; methods ; Gastroenterostomy ; Humans ; Stomach Neoplasms ; surgery

Compared to that with laparoscopic assisted approach, intracorporeal anastomosis with totally laparoscopic radical total gastrectomy has the advantages of smaller incision, and better vision for operation, and may also be fit for patients with large size lesion, high-located lesions, or obesity. It remains controversial though several surgeons have reported the safety and feasibility of intracorporeal anastomosis with totally laparoscopic total gastrectomy. This review describes the recent technical advances in intracorporeal anastomoses with totally laparoscopic total gastrectomy, focusing on the reconstruction skills and indications. Current data on totally laparoscopic total gastric resection for gastric carcinoma revealed that all digestive tract reconstructions were performed with esophagus-jejunum Roux-en-Y anastomosis, and different reconstruction techniques of such Roux-en-Y anastomosis have certain advantages and disadvantages. Surgeons should make choice based on tumor location, esophageal diameter and personal skills in order to achieve maximal benefit to patients.
Anastomosis, Roux-en-Y ; methods ; Gastrectomy ; methods ; Humans ; Laparoscopy ; methods ; Stomach Neoplasms ; surgery

OBJECTIVETo explore the effect of electroacupuncture on myoelectric activity of Jejunal limb after Roux-en-Y esophagojejunostomy.

METHODSFourteen health young pigs were randomly divided into 2 groups, an experimental group (total gastrectomy and Roux-en-Y esophagojejunostomy was carried out) and a control group (the abdominal cavity was closed after the electrode was placed), 7 pigs in each group. Electroacupunture was given at "Zusanli" (ST 36) in the experimental group. The changes of myoelectrogram of the jejunal limb was investigated.

RESULTSCompared with the control group, the amplitude and the frequency of the slow wave, and the amplitude and incidence rate of the spike potential in the experimental group were changed significantly; the duration of migrating motor complex (MMC) phase III was (2.6 +/- 0.7) minutes in the experimental group, which was significantly shorter than (7.1 +/- 1.1) minutes in the control group. Electroacupuncture did not significantly influence the amplitude and the frequency of the slow wave, but could increased significantly the incidence rate and the amplitude of the spike potential; after electroacupuncture, the duration of MMC phase III was (5.7 +/- 0.9) minutes, which was significantly longer than (2.6 +/- 0.7) minutes before electroacupuncture.

CONCLUSIONElectroacupuncture at "Zusanli" (ST 36) can relieve the Roux-en-Y stasis syndrome through influencing myoelectric activity of the jejunum.

OBJECTIVETo investigate the feasibility and safety of totally laparoscopic distal gastrectomy.

METHODSClinical data of 25 patients with distal gastric cancer undergoing totally laparoscopic distal gastrectomy between December 2011 and January 2013 were analyzed retrospectively. Only laparoscopic linear stapler was used in intracorporeal delta-shaped or Roux-en-Y anastomosis for reconstruction.

RESULTSNo patient required conversion to laparoscopy-assisted or open surgery. The mean total operative time and anastomotic time were (256±23.6) min and (35.7±8.4) min respectively in patients with delta-shaped anastomosis, and (287±11.5) min and (46.4±12.1) min in those with Roux-en-Y anastomosis. The mean blood loss was(109.6±42.3) ml, and the mean number of stapler used was 5.6. The mean time to the first flatus was (2.8±1.2) d, and mean time liquid diet to resume was (3.5±0.9) d. Postoperative complication occurred in 3 patients(12.0%).

CONCLUSIONTotally laparoscopic distal gastrectomy with intracorporeal anastomosis using laparoscopic linear stapler is safe and feasible.