BACKGROUNDThe ideal post-gastrectomy reconstruction procedure should maintain the normal digestive function and restore intestinal transit to improve the patient quality of life. The aim of this study was to evaluate the effects of integral continual jejunal interposition after subtotal gastrectomy on the nutritional status, glucose levels, and gastric-intestinal motility.

METHODSThe study investigated the effects of the integral continual jejunal interposition, the Billroth I and Billroth II operations, and the isolated jejunal interposition following subtotal distal gastrectomy on the blood glucose, insulin, routine blood parameters, liver function, and myoelectrical activity in Beagle dogs.

RESULTSThe weights of the dogs decreased during the first post-operative weeks. Dogs in the integral continual jejunal interposition, Billroth I, and Billroth II groups gained significantly more weight by 8 weeks. The prognosis nutrition index of the dogs decreased in the first 2 post-operative weeks and increased significantly by 4 weeks in the integral continual jejunal interposition and Billroth I groups. The group with duodenal exclusion (Billroth II) had significantly higher glucose levels compared to the normal control group. The insulin curve was much higher in dogs that underwent the Billroth I, continual jejunal interposition, and isolated jejunal interposition than the Billroth II and normal groups. The frequencies of fasting and postprandial jejunal pacesetter potentials (PPs) were greater in the continual jejunal interposition and Billroth I groups than that in the isolated jejunal interposition and Billroth II groups. The percentage of aboral propagation of PPs was greater in the continual jejunal interposition group than the Billroth I, isolated jejunal interposition, and Billroth II groups.

CONCLUSIONContinual jejunal interposition after subtotal gastrectomy avoids jejunal transection, maintains the duodenal passage and food storage bags, and reduces the influence of blood glucose and insulin.

Animals ; Dogs ; Gastrectomy ; methods ; Gastroenterostomy ; methods ; Jejunum ; pathology ; surgery ; Reconstructive Surgical Procedures ; methods

Digestive reconstruction after gastrectomy is one of the key steps to the success of surgery. The surgical difficulty is greater for digestive reconstruction after laparoscopic-assisted gastrectomy (LAG). In order to reduce the incidence of postoperative complication and ensure a good quality of life for patients after gastrectomy, surgeons should have experience in open surgery and proper reconstruction technique and surgical instruments should be selected.
Gastrectomy ; methods ; Gastroenterostomy ; methods ; Humans ; Laparoscopy ; methods ; Reconstructive Surgical Procedures ; Stomach Neoplasms ; surgery

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

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

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

OBJECTIVETo compare the outcome between retrosternal and posterior mediastinal gastric tube reconstruction after three-phase esophagectomy.

METHODSA total of 107 patients who underwent three-phase esophagectomy between July 2005 and May 2009 were enrolled in this study.

RESULTSThere were 78 men and 29 women. Median age was 62.1 years. The tumor located at upper segment in 20 cases, middle segment in 69 cases and lower segment in 18 cases. There were 55 patients in the posterior mediastinal group and 52 in the retrosternal group. There were no significant differences between two groups in operation time, intraoperative blood loss, duration of chest tube. Hospital stay of retrosternal group was longer as compared to posterior mediastinal group. No death occurred in both groups. Anastomotic leakage occurred more frequently in retrosternal group than that in posterior mediastinal group (26.9% vs 5.5%). Postoperative pneumonia, atelectasis and arrhythmia were not significantly different between two groups.

CONCLUSIONSAfter three-phase esophagectomy, both retrosternal and posterior mediastinal gastric tube reconstruction can be performed easily and safely. Morbidity of anastomotic leakage is higher in retrosternal reconstruction. Individualized gastric tube reconstruction should be considered.

Aged ; Anastomosis, Surgical ; Esophageal Neoplasms ; surgery ; Esophagectomy ; Female ; Gastroenterostomy ; methods ; Humans ; Male ; Middle Aged ; Stomach ; surgery

OBJECTIVETo evaluate the efficacy and safety of posterior mediastinal route (PR) as compared with anterior mediastinal route (AR) after esophagectomy.

METHODSA systematic literature retrieval was carried out to obtain studies of randomized controlled trials (RCT) comparing PR with AR after esophagectomy before June 2012. Study selection, data collections and methodological quality assessments of retrieved studies were independently performed by two individual reviewers and meta-analysis was conducted using the RevMan 5.0 software.

RESULTSSix RCTs involving 376 patients (PR:197 cases, AR:179 cases) met the selection criteria. Meta-analysis showed that operative mortality (RR=0.49, 95%CI:0.18-1.36), anastomotic leaks (RR=0.95, 95%CI:0.44-2.07), cardiac morbidity (RR=0.51, 95%CI:0.25-1.04), pulmonary morbidity (RR=0.69, 95%CI:0.41-1.15), anastomotic strictures (RR=0.88, 95%CI:0.62-1.25), dysphagia (RR=1.26, 95%CI:0.75-2.11), 6-month body weight after esophagectomy were not significantly different between these two routes of reconstruction (all P>0.05).

CONCLUSIONAR should be the choice of reconstruction in view of its potential advantages in the prevention of tumor recurrence within the gastric conduit and avoidance of conduit irradiation when undergoing postoperative radiotherapy. However, further studies are needed to confirm the difference of long-term efficacy between the two routes.

Esophageal Neoplasms ; surgery ; Esophagectomy ; Gastroenterostomy ; methods ; Humans ; Randomized Controlled Trials as Topic ; Stomach ; surgery

Compared with distal gastrectomy, pylorus-preserving gastrectomy is less invasive which can decrease incidence of dumping syndrome, diarrhea and body weight lost, cholecystitis and gallstone, reflux gastritis and esophagitis and remnant gastric cancer. Based on new Japanese Gastric Cancer Treatment Guideline and new progression in the world, we give a review mainly basic characteristics, indications, operation details and short- and long-time outcomes after pylorus-preserving gastrectomy.
Gastrectomy ; methods ; Gastric Stump ; pathology ; Gastroenterostomy ; Humans ; Organ Sparing Treatments ; Pylorus ; surgery ; Stomach Neoplasms ; surgery

OBJECTIVETo explore the technical feasibility, safety, and clinical efficacy of delta-shaped anastomosis in totally laparoscopic distal gastrectomy (TLDG).

METHODSClinical data of 18 patients with gastric cancer who received TLDG with delta-shaped anastomosis from November 2012 to December 2012 were retrospectively analyzed. The delta-shaped anastomosis is a new method of intraabdominal Billroth I anastomosis using only linear stapler. The posterior wall of the stomach and that of the duodenum were put together using linear stapler, and the common stab incision was also closed with linear stapler. The anastomosis was finished with a delta-shaped.

RESULTSTLDG with delta-shaped anastomosis was successfully carried out in all the patients. The mean operation time and mean time for anastomosis were (156.3 ± 38.5) minutes and (24.6 ± 11.2) minutes. The lengths of upper and lower segment of resection form gastric cancer were (5.8 ± 2.4) cm and (4.1 ± 2.7) cm. Blood loss was (70.7 ± 43.8) ml and number of dissected lymph nodes was 32.4 ± 12.0 per patient. The average time to ground activities, time to flatus, time to fluid diet and length of hospital stay were (1.8 ± 0.9) days, (3.1 ± 1.2) days, (3.6 ± 1.7) days, and (9.6 ± 2.5) days, respectively. Only one patient developed chylus leak with intraabdominal infection. There was no mobility related to the anastomosis in all the patients.

CONCLUSIONThe delta-shaped anastomosis is a safe and feasible procedure for totally laparoscopic distal gastrectomy and provides satisfactory short-term efficacy.

Adult ; Aged ; Female ; Gastrectomy ; methods ; Gastroenterostomy ; methods ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

BACKGROUND: The results of studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) reconstruction on the quality of life (QoL) are still inconsistent. The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer. METHODS: A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital, Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group ( N  = 70) and R-Y group ( N  = 70). The follow-up time points were 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after the operation. The final follow-up time was May 2019. The clinicopathological features, operative safety, postoperative recovery, long-term survival as well as QoL were compared, among which QoL score was the primary outcome. An intention-to-treat analysis was applied. RESULTS: The baseline characteristics were comparable between the two groups. There were no statistically significant differences in terms of postoperative morbidity and mortality rates, and postoperative recovery between the two groups. Less estimated blood loss and shorter surgical duration were found in the B-I group. There were no statistically significant differences in 5-year overall survival (79% [55/70] of the B-I group vs. 80% [56/70] of the R-Y group, P  = 0.966) and recurrence-free survival rates (79% [55/70] of the B-I group vs. 78% [55/70] of the R-Y group, P  = 0.979) between the two groups. The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences (postoperative 1 year: 85.4 ± 13.1 vs . 88.8 ± 16.1, P  = 0.033; postoperative 3 year: 87.3 ± 15.2 vs . 92.8 ± 11.3, P  = 0.028; postoperative 5 year: 90.9 ± 13.7 vs . 96.4 ± 5.6, P  = 0.010), and the reflux (postoperative 3 year: 8.8 ± 12.9 vs . 2.8 ± 5.3, P  = 0.001; postoperative 5 year: 5.1 ± 9.8 vs . 1.8 ± 4.7, P  = 0.033) and epigastric pain (postoperative 1 year: 11.8 ± 12.7 vs. 6.1 ± 8.8, P  = 0.008; postoperative 3 year: 9.4 ± 10.6 vs. 4.6 ± 7.9, P  = 0.006; postoperative 5 year: 6.0 ± 8.9 vs . 2.7 ± 4.6, P  = 0.022) were milder in the R-Y group than those of the B-I group at the postoperative 1, 3, and 5-year time points. CONCLUSIONS: Compared with B-I group, R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain, without changing survival outcomes. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR-TRC-10001434.
Humans ; Stomach Neoplasms/pathology* ; Anastomosis, Roux-en-Y/methods* ; Quality of Life ; Treatment Outcome ; Gastrectomy/methods* ; Postoperative Complications ; Gastroenterostomy/methods* ; Pain