Purpose: This study aims to compare the health economics and quality of life between uncut Roux-en-Y and Roux-en-Y reconstruction after laparoscopic-assisted total gastrectomy.Methods: Between January 2016 and January 2019, 164 patients underwent laparoscopic-assisted total gastrectomy (uncut Roux-en-Y reconstruction, n = 71; Roux-en-Y, n = 93). The patients’ data were collected and reviewed retrospectively.Results: The perioperative index, operating time, digestive tract reconstruction time, and first postoperative exhaust time of the U-RY group were shorter than those of the RY group (P < 0.05). Differences in the quality of life (QoL) index 12 months postoperation were not significantly different between the groups (P > 0.05). No recanalization was found in the U-RY obliterated afferent jejunal limb. The cost of mechanical staples andaverage hospitalization in the U-RY group were significantly lower than that in the RY group (P < 0.05).Conclusion: The postoperative health economics of U-RY reconstruction may be superior to those of RY reconstruction after laparoscopic-assisted total gastrectomy. The QoL of the U-RY group is similar to that of the RY group.

BackgroundUncut Roux-en-Y (U-RY) has been increasingly used in radical gastric cancer surgery, but it is still in the exploratory stage. There is insufficient evidence for its long-term efficacy.MethodsFrom January 2012 to October 2017, a total of 280 patients diagnosed with gastric cancer were eventually included in this study. Patients undergoing U-RY were assigned to the U-RY group, while patients undergoing BillrothII with Braun (B II + Braun) were assigned to the B II + Braun group.ResultsThere were no significant differences between the two groups in operative time, intraoperative blood loss, postoperative complications, first exhaust time, time to liquid diet, and length of postoperative hospital stay (all P &gt; 0.05). Endoscopic evaluation was performed 1 year after surgery. Compared to B II + Braun group, the uncut Roux-en-Y group had significantly lower incidences of gastric stasis [16.3% (15/92) vs. 28.2% (42/149), χ2 = 4.448, P = 0.035], gastritis [13.0% (12/92) vs. 24.8% (37/149), χ2 = 4.880, P = 0.027] and bile reflux [2.2% (2/92) vs. 20.8% (11/149), χ2 = 16.707, P &lt; 0.001], and the differences were statistically significant. The questionnaire was completed 1 year after surgery,the QLQ-STO22 scores showed that, the uncut Roux-en-Y group had a lower pain score(8.5 ± 11.1 vs. 11.9 ± 9.7, P = 0.009) and reflux score(7.9 ± 8.5 vs. 11.0 ± 11.5, P = 0.012), and the differences were statistically significant (P &lt; 0.05). However, there was no significant difference in overall survival (P = 0.688) and disease-free survival (P = 0.505) between the two groups.ConclusionUncut Roux-en-Y has the advantages of better safety, better quality of life and fewer complications, and is expected to be one of the best methods for digestive tract reconstruction.

Introduction: At present, there is no convincing evidence-based medical basis for the placement of prophylactic drain after gastrectomy.This meta-analysis aimed to analyze the incidence of complications and the recovery of gastrointestinal function after gastrectomy in the drain group and the no-drain group. Methods: Data were retrieved from electronic databases PubMed, EMBASE, Medline, Cochrane Library, CNKI, Wanfang and VIP databases up to December 2022, including the outcomes of individual treatment after gastrectomy. Complication related index:Incidence of Postoperative Complications, Anastomotic leak，Intra-abdominal bleeding, Wound Infection, Hospital mortality, Pulmonary infection, Intra-abdominal abscess, Abdominal infection, Readmission, Reoperation, Drain related complications etc. Recovery of gastrointestinal function related index: Passage of flatus, Initiation of soft diet, Hospital stay after surgery. The Jadad score and Newcastle-Ottawa scale were used to assess the quality of the included studies. Results: After screening, 20 literatures were finally included, including 4984 patients. Meta-analysis results showed that the passage of flatus（WMD=0.32, 95%CI=0.07~0.58, P=0.01）and initiation of soft diet（WMD=0.45, 95%CI=0.20~0.71, P=0.0005）in the no-drain group were better than those in the drain group. The drain group was not superior to the no-drain group in hospital stay after surgery, postoperative complications, wound infection, pulmonary infection, anastomotic leakage, intra-abdominal abscess, intra-abdominal bleeding, intra-abdominal infection, mortality, reoperation, readmission, and drainage-related complications. Conclusions: Prophylactic placement of the peritoneal drainage tube did not reduce the incidence of early complications but delayed recovery of gastrointestinal function. Abdominal drainage is not required after radical gastrectomy, but is recommended for high-risk patients with anastomotic fistula and intraperitoneal bleeding.

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