Comparison of surgical outcomes between Roux-en Y and Uncut Roux-en Y anastomosis after laparoscopic distal gastrectomy for gastric cancer.

Dong Joon Shin, Hyung-Ho Kim, Do Joong Park, Sang-Hoon Ahn, Sang-Yong Son, Do Hyun Jung, Young Suk Park. Seoul National University Bundang Hospital

Background Postoperative complications occurred after distal gastrectomy with Roux en Y anastomosis for gastric cancer is the cause that makes impedes the quality of life (QOL) for the patients. The aim of this study is to investigate the more effective anastomosis method in terms of improve QOL after distal gastrectomy for gastric cancer.

Method We analyzed 529 patients who underwent laparoscopic distal gastrectomy in Seoul National University Bundang hospital from March 2006 to October 2013. The eligible patients were divided into two groups based on anastomosis method: Roux-en Y (n=62) and Uncut Roux-en Y (n=467). We analyzed postoperative complications including Roux stasis syndrome in each group. Delayed gastric emptying without mechanical obstruction after Roux-en-Y reconstruction has been defined as Roux stasis syndrome.

Results The operating time was significantly longer in the Roux-en Y group (224.1±57.3 min) than in the Uncut Roux-en Y group (189.7±60.8min), (P=0.001). There was no significant difference in the post-operative complications such as wound infection (4.8% vs. 1.7%, P = 0.128), anastomosis site leakage (3.2% vs. 0.4%, P = 0.069), postoperative bleeding (3.2% vs. 0.4%, P=0.069), duodenal stump leakage (1.6% vs. 1.1%, P=0.528), pancreatic fistula (9.7% vs. 3.2%, P = 0.027). Roux stasis syndrome was significantly higher in the Roux-en Y group than in the Uncut Roux-en Y group (24.2% vs. 3.2%, P = 0.001).

Conclusion We conclude that Uncut Roux-en Y reconstruction technique is superior to Roux-en Y reconstruction technique in terms of Roux stasis syndrome and operating time.