With less injury and faster postoperative recovery, laparoscopic techniques have been widely applied in D2 radical gastrectomy for distal gastric cancer. Billroth I anastomosis is a common reconstruction procedure in ...With less injury and faster postoperative recovery, laparoscopic techniques have been widely applied in D2 radical gastrectomy for distal gastric cancer. Billroth I anastomosis is a common reconstruction procedure in D2 radical gastrectomy for distal gastric cancer. The delta-shaped anastomosis, an intra-abdominal Billroth I reconstruction, has been increasingly applied by gastrointestinal surgeons. This surgical video demonstrates the delta-shaped anastomosis in laparoscopic-assisted D2 radical gastrectomy for distal gastric cancer.展开更多
BACKGROUND Conventional Billroth Ⅱ(BⅡ) anastomosis after laparoscopic distal gastrectomy(LDG) for gastric cancer(GC) is associated with bile reflux gastritis, and Roux-enY anastomosis is associated with Roux-Y stasi...BACKGROUND Conventional Billroth Ⅱ(BⅡ) anastomosis after laparoscopic distal gastrectomy(LDG) for gastric cancer(GC) is associated with bile reflux gastritis, and Roux-enY anastomosis is associated with Roux-Y stasis syndrome(RSS). The uncut Rouxen-Y(URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BⅡ with Braun(BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.AIM To evaluate the value of URY in patients with GC.METHODS PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals(VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal(https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com). We cited highquality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials(RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager(Version 5.4).RESULTS Eight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval(CI): 0.03-0.19, P < 0.00001] was significantly lower in the URY group than in the BB group. The pH of the postoperative gastric fluid was lower in the URY group than in the BB group at 1 d [mean difference(MD) =-2.03, 95%CI:(-2.73)-(-1.32),P < 0.00001] and 3 d [MD =-2.03, 95%CI:(-2.57)-(-2.03), P < 0.00001] after the operation. However,no significant difference in all the intraoperative outcomes was found between the two groups.CONCLUSION This work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.展开更多
Total laparoscopic-assisted radical gastrectomy and the jejunal Roux-en-Y anastomosis were performed to treat cancer of the upper gastric body and fundic region. In the case of open anastomosis during total laparoscop...Total laparoscopic-assisted radical gastrectomy and the jejunal Roux-en-Y anastomosis were performed to treat cancer of the upper gastric body and fundic region. In the case of open anastomosis during total laparoscopic-assisted radical gastrectomy, an incision of 6-8 cm would be required due to the need for placing the stapler anvil. If using the Roux-en-Y procedure, however, the incision could be reduced to as small as 4-5 cm without increasing the length of operation and intraoperative bleeding that favors postoperative recovery.展开更多
文摘With less injury and faster postoperative recovery, laparoscopic techniques have been widely applied in D2 radical gastrectomy for distal gastric cancer. Billroth I anastomosis is a common reconstruction procedure in D2 radical gastrectomy for distal gastric cancer. The delta-shaped anastomosis, an intra-abdominal Billroth I reconstruction, has been increasingly applied by gastrointestinal surgeons. This surgical video demonstrates the delta-shaped anastomosis in laparoscopic-assisted D2 radical gastrectomy for distal gastric cancer.
基金Supported by Natural Science Foundation of Gansu Province,China,No.18JR3RA052National Scientific Research Project Cultivation Plan of Gansu Provincial People’s Hospital,No.19SYPYA-1+1 种基金National Key Research and Development Program,No.2018YFC1311506Gansu Province Da Vinci Robot High End Diagnosis and Treatment Personnel Training Project,No.2020RCXM076.
文摘BACKGROUND Conventional Billroth Ⅱ(BⅡ) anastomosis after laparoscopic distal gastrectomy(LDG) for gastric cancer(GC) is associated with bile reflux gastritis, and Roux-enY anastomosis is associated with Roux-Y stasis syndrome(RSS). The uncut Rouxen-Y(URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BⅡ with Braun(BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.AIM To evaluate the value of URY in patients with GC.METHODS PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals(VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal(https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com). We cited highquality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials(RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager(Version 5.4).RESULTS Eight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval(CI): 0.03-0.19, P < 0.00001] was significantly lower in the URY group than in the BB group. The pH of the postoperative gastric fluid was lower in the URY group than in the BB group at 1 d [mean difference(MD) =-2.03, 95%CI:(-2.73)-(-1.32),P < 0.00001] and 3 d [MD =-2.03, 95%CI:(-2.57)-(-2.03), P < 0.00001] after the operation. However,no significant difference in all the intraoperative outcomes was found between the two groups.CONCLUSION This work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.
文摘Total laparoscopic-assisted radical gastrectomy and the jejunal Roux-en-Y anastomosis were performed to treat cancer of the upper gastric body and fundic region. In the case of open anastomosis during total laparoscopic-assisted radical gastrectomy, an incision of 6-8 cm would be required due to the need for placing the stapler anvil. If using the Roux-en-Y procedure, however, the incision could be reduced to as small as 4-5 cm without increasing the length of operation and intraoperative bleeding that favors postoperative recovery.
