Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction: one group with gastroesophagostomy (GE group) and the other with accommodation double tract digestive reconstruction of jejunal interposition (GIE group). The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation: the value of weight, RBC, Hb, Alb, PNI and the indexes versus the preoperative ones (Pgt;0.05), for the exception of the indexes of RBC (P=0.006), Hb (P=0.001) in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group (Plt;0.001). The Visick scoring: most of the GIE group were gradeⅡ (74.2%), and grade Ⅲ (64.3%) in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group (Pgt;0.05), and the surgical time was (0.35±0.13) h more than that of GE group (P=0.01). Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.
The incidence of esophagogastric junction adenocarcinoma is gradually increasing, and gastrointestinal surgery and thoracic surgery are paying more and more attention to its surgical treatment. “Chinese expert consensus on the surgical treatment of adenocarcinoma of esophagogastric junction (2018 edition)” discussed the core issues in the field of surgical treatment such as definition, classification, surgical approach, lymphadenectomy, digestive tract reconstruction, and neoadjuvant therapy for esophagogastric junction adenocarcinoma, and gave recommendations. However, there is still some controversy about these issues. The author discussed the consensus and controversial issues relevant to esophagogastric junction adenocarcinoma and related research progress in recent years.
ObjectiveTo evaluate the safety and efficacy of Roux-en-Y reconstruction with isolated pancreatico-jejunostomy after pancreaticoduodenectomy. MethodsSystematically literature search was performed through PubMed, EMBASE, Cochrane Library, Wanfang, VIP, and CNKI from the earliest to November 30, 2015. Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) comparing outcomes of Roux-en-Y reconstruction with isolated pancrea-ticojejunostomy and conventional pancreaticojejunostomy were searched. The data were applied meta-analysis by RevMan 5.3. ResultsSeven trials were involved, two RCTs including 367 patients and five CCTs including 431 patients. Meta-analysis result showed that there was no statistic significant difference in pancreas fistula between Roux-en-Y reconstruction with isolated pancreaticojejunostomy and conventional pancreaticojejunostomy. ConclusionRoux-en-Y reconstruction with isolated pancreaticojejunostomy after pancreaticoduodenectomy is not superior to conventional pancreaticojejunostomy regarding pancreatic fistula rate or other relevant outcomes.
Motor function was investigated by constant perfusion manometry in the Roux limb of ten patients who had undergone total gastrectomy and Roux-en-Y anastomosis. Results showed that in the fasting state, the migrating motor complex (MMC) was comletely absent, retrograde in direction or bursts of nonphasic pressure activity. Reduced motor activity patterns occurred after the meal in some patients. Four patients failed to convert fasting state into the feeding state. Total gastrectomy with Roux-en-Y anastomoses provakes a relatively severe distubance in motor function, which could contribute to postoperative upper abdominal distress.
Objective To summarize recent progress of three types of basic digestive tract reconstruction methods after distal gastrectomy for gastric cancer. Methods Recent domestic and international literatures about three types of basic digestive tract reconstruction methods after distal gastrectomy for gastric cancer were collected and analyzed. Results Of the three types of basic digestive tract reconstruction methods, BillrothⅠanastomosis had the most obvious advantage compared to BillrothⅡanastomosis and Roux-en Y anastomosis, but it was limited by tumor' size. The performance of BillrothⅡanastomosis was relatively easier but its complication risk was higher. Roux-en-Y anastomosis was superior in body weight control and treatment of type 2 diabetes mellitus, and had a wider indication than the other two types of methods. The modified uncut Roux-en-Y anastomosis was easier to perform under laparoscopic surgery. Conclusions Each method of the three types of basic digestive tract reconstruction methods after distal gastrectomy has its own superiority and indication. Therefore, the choice of digestive tract reconstruction method after distal gastrectomy should be case by case.