Abstract: Objective:To investigate the application and clinical effect of uncut RouxenY (uncut RY) anastomosis in laparoscopic distal radical gastrectomy of gastric cancer.
Methods:The retrospective crosssectional study was adopted. The clinical data of 23 patients with gastric cancer who were admitted to the Northern Jiangsu People′s Hospital from December 2014 to July 2015 were collected. All the 23 patients underwent laparoscopyassisted distal gastrectomy (LADG) and total laparoscopic distal gastrectomy (TLDG) according to the individual situations. The indexes of observation were collected, including (1) intraoperative indexes: operation time, uncut RY anastomosis time and volume of inraoperative blood loss, (2) postoperative indexes: time to anal exsufflation, time for initial water intake, time for semifluid diet intake, time for outoffbed activity, duration of hospital stay, occurrence of complications and results of pathological examination, (3) results of followup. The followup was performed by outpatient examination and telephone interview up to November 2015, including postoperative discomfort after diet intake, barium meal examination of gastrointestinal tract at postoperative month 1 (anastomotic stenosis, recanalization and dehiscence of occlusion), detecting situations of gastric remnant and anastomotic stoma at postoperative month 3 by gastroscopy and occurrence of gastrointestinal obstruction. Measurement data with normal distribution were presented as ±s.
Results: (1) Intraoperative situations: all the 23 patients underwent successful uncut RY anastomosis, including 18 receiving LADG and 5 receiving TLDG. The operation time, uncut RY anastomosis time and volume of intraoperative blood loss were (165.9±11.6)minutes, (18.2±2.2)minutes, (48±6)mL in all the 23 patients and (172.0±8.5)minutes, (26.6±1.5)minutes, (46±4)mL in 5 patients with TLDG, respectively. Two patients received hemostatic treatment using suture and hemostatic forceps due to anastomotic bleeding. (2) Postoperative situations: time to anal exsufflation, time for initial water intake, time for semifluid diet intake, time for outoffbed activity, duration of hospital stay and incidence of complications in all the 23 patients were (2.2±0.4)days, (2.7± 0.4)days, (3.5±0.4)days, (2.7±0.3)days, (10.6±1.4)days and 8.7%(2/23), respectively. No patient was dead in the perioperative period. Two patients complicated with incisional infection and high fever were cured by symptomatic treatment, without occurrence of anastomotic leakage, bleeding and anastomoticrelated complications. All the patients received postoperative barium meal examination of upper gastrointestinal tract, with unblocked anastomotic stoma and without leakage of barium meal. Diameter of tumor and number of lymph node dissected were (3.2±1.2)cm and 30±4, with negative upper and lower resection margins. Numbers of patients with tumor differentiation, T stage, N stage and TNM stage were 12 and 11 in differentiated and undifferentiated tumors, 1,9 and 13 in T1, T2 and T3 stages, 9, 11 and 3 in N0, N1and N2 stages, 1, 4, 9, 6 and 3 in Ⅰa, Ⅰb, Ⅱ, Ⅲa and Ⅲb stages, respectively. (3) All the 23 patients were followed up by outpatient examination for 3-11 months. One patient had discomfort in upper abdomen with vomiting at postoperative week 3, and no anastomotic leakage, bleeding and anastomoticrelated complications were occurred in other patients.
Conclusion As a modified anastomotic method, uncut RY anastomosis is safe and feasible, and it is also an ideal method of digestive tract reconstruction after laparoscopic distal radical gastrectomy.