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

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

Recurrent tumour after radical pancreaticoduodenectomy may cause obstruction of the small bowel loop draining the liver. Roux-loop obstruction presents a particular therapeutic challenge, since the postsurgical anatomy usually prevents endoscopic access. Careful multidisciplinary discussion and multimodality preprocedure imaging are essential to accurately demonstrate the cause and anatomical location of the obstruction. Transhepatic or direct percutaneous stent placement should be possible in most cases, thereby avoiding long-term external biliary drainage. Gastropexy T-fasteners will secure the percutaneous access and reduce the risk of bile leakage. The static bile is invariably contaminated by gut bacteria, and systemic sepsis is to be expected. Enteral stents are preferable to biliary stents, and compound covered stents in a sandwich construction are likely to give the best long-term results. Transhepatic and direct percutaneous enteral stent insertion after jejunopexy is illustrated and the literature reviewed.
Anastomosis, Roux-en-Y ; Bacteria ; Bile ; Cholestasis ; Drainage ; Gastropexy ; Jaundice, Obstructive ; Jejunostomy ; Liver ; Pancreaticoduodenectomy ; Sepsis ; Stents

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*

One hundred gastric cancer patients who underwent total gastrectomy and Roux-en-Y, end-to-side esophagojejunostomy by using stapling devices were analyzed with regard to their operative results. The median time required for the anastomosis was 18 minutes (range of 15 to 45 minutes). A cartridge of 25 mm in diameter was preferred (85% of 25 mm vs. 15% of 28 mm). In 92 patients, procedures were uneventful. Intraoperative problems happened in 8 patients: Two misfirings of stapler due to mechanical problems, in 6 patients, doughnut tissues were incomplete. Mechanical problems were solved by a change of the stapler and for incomplete doughnut tissues, anastomosis was simply reinforced (2 cases) or reanastomosed with restaplings (4 cases). Anastomotic leakage occurred in 2 patients but it was seen only in radiological studies. During the follow up period, two cases of anastomotic stricture were found and they were treated with endoscopic dilatations. There was no operative mortality nor other complication. In addition, routine use of the Levin tube after total gastrectomy was appraised by comparing postoperative courses. Twenty patients were randomly divided into two groups; for 10 patients the Levin tube was removed at the recovery room and for another 10 patients the Levin tube was indwelled until peristalsis returned. Timing of the tube removal did not affect the duration of the hospital stay and starting day of oral intake. We think that the stapler, when properly used, can facilitate the esophagojejunostomy safely and routine use of the Levin tube after total gastrectomy may be unnecessary.
Adult ; Aged ; *Anastomosis, Roux-en-Y ; *Esophagostomy ; Female ; *Gastrectomy ; Human ; *Jejunostomy ; Male ; Middle Age ; *Surgical Staplers

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 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.

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