Researchers do not recommend uncut Roux-en-Y reconstruction for laparoscopic gastrectomy
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Key takeaways:
- Using linear staplers cannot effectively block recanalization of the afferent limb.
- Uncut Roux-en-Y reconstruction is not recommended until a means to reduce the recanalization rate is identified.
Patients who underwent uncut Roux-en-Y had more severe gastrointestinal symptoms and higher incidence of residual gastritis and degree of bile reflux, while experiencing no reduction in stasis syndrome compared with traditional Roux-en-Y.
“The most common surgical approach for gastric antrum malignancies is radical gastrectomy. ... As technology advances, laparoscopy-assisted distal gastrectomy (LADG) has gained popularity for general surgeons because of better postoperative outcomes,” Huahao Xie, of the department of surgery at Tongji University in Shanghai, and colleagues wrote in the Journal of Gastrointestinal Surgery. “To further improve the surgical method, some scholars developed uncut Roux-en-Y anastomosis. ... However, according to previous studies, the afferent limb recanalization rate ranges from 2.9% to 35.7% after uncut Roux-en-Y anastomosis.”
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In a prospective, randomized controlled trial, Xie and colleagues aimed to investigate the recanalization rate of the afferent loop and compare long-term outcomes, including Roux-en-Y stasis syndrome (RSS), between uncut Roux-en-Y (URY) and traditional Roux-en-Y (RY). They enrolled 108 patients scheduled for laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy and divided them into URY (n = 57) and RY (n = 51) groups.
One year after surgery, 73.7% of patients developed afferent loop recanalization. Although the incidence of postoperative RSS did not differ between patients in the URY (15.8%) or RY groups (19.6%; OR = 1.301; 95% CI, 0.482-1.509), the postoperative Gastrointestinal Symptom Rating Scale (GSRS) score was “substantially higher” in the URY group.
Further analysis showed patients in the URY group had a “significantly higher” grade of residual gastritis and incidence of bile reflux, but there was no difference in reflux esophagitis grade between groups (95% CI, 0.437-0.457).
Researchers also examined the effect of recanalization on follow-up outcomes among patients in the URY group by dividing them into recanalization (n = 42) and nonrecanalization (n = 15) groups. Although there was no difference in the grade of reflux esophagitis (95% CI, 0.184-0.2) between groups, the incidence of residual gastritis (95% CI, 0.046-0.054) and degree of bile reflux (OR = 4.8; 95% CI, 1.37-16.812) were higher in the recanalization group.
Further, although there was no difference in the incidence of RSS (OR = 0.304; 95% CI, 0.035-2.659), the GSRS score among patients in the recanalization group was higher compared with patients in the RY group (95% CI, 0.037-0.044).
“This study shows that the linear stapler cannot effectively block the recanalization of the afferent limb,” Xie and colleagues wrote. “Due to the high recanalization rate, the URY group developed more severe gastrointestinal symptoms, bile reflux and had an increased residual gastritis incidence, and did not have a reduced incidence of postoperative RSS.”
They continued, “Therefore, uncut Roux-en-Y reconstruction is not recommended before finding a way to reduce the recanalization rate.”
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