A new approach for Roux-en-Y reconstruction after pancreaticoduodenectomy

Xu, Meng; Wang, Min; Zhu, Feng; Tian, Rui; Shi, Changcheng; Wang, Xin; Shen, Ming; Qin, Renyi

doi:10.1016/s1499-3872(14)60047-3

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…In 1887, Monastyski first reported cholecystojejunostomy, and the following year, Riedl pioneered choledochoduodenostomy. In 1893, César Roux designed a Roux-en-Y jejunal loop for gastrojejunostomy, later used in CJS to prevent intestinal fluid reflux (15). At present, Roux-en-Y CJS is the most commonly used method for bile duct reconstruction in the clinical setting (16,17).…”

Section: Discussionmentioning

confidence: 99%

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Lyu¹,

Wang²,

Zhou³

et al. 2021

Ann Transl Med

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Background:The present study aimed to analyze the scar formation mechanism following Roux-en-Y choledochojejunostomy (CJS) in a novel rat model of obstructive jaundice. Methods:The biliary obstruction model of Sprague-Dawley (SD) rats was established in advance, and 24 rats were randomly divided into 4 groups (control group, 1-day ligation group, 3-day ligation group, and 5-day ligation group). Changes in postoperative weight, common bile duct diameter, and laboratory indexes were analyzed to determine the best operation time. Roux-en-Y CJS in rats was studied based on the model, and the rats were randomly divided into 4 groups [control group, 3-day choledochojejunostomy (CJS) group, 7-day CJS group, and 30-day CJS group]. The same indexes were analyzed, and the characteristics of scar formation were evaluated by histopathology and polymerase chain reaction examination.Results: The third day after common bile duct ligation is the best time for a Roux-en-Y CJS. The common bile duct diameter expands to 4.2 mm on average, and these physiological characteristics are consistent with current standard clinical findings. After completing CJS, the rats' weight returned to normal levels, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), direct bilirubin (DB), and C-reactive protein (CRP) indexes gradually decreased (P<0.05). Anastomotic stoma diameter tended to narrow with time and was significantly narrower on day 30 than preoperation. After CJS, the expression of α-smooth muscle actin (α-SMA) peaked in the early stage and was still higher than that of the control group in the bile duct wall 1 month postoperatively (P<0.05). Transforming growth factor-β1 (TGF-β1) expression gradually increased and was higher than that of the control group at each stage postoperatively (P<0.05). Conclusions:The rat Roux-en-Y CJS model is more in line with our surgical model, and the clinical condition has potential applicability for the study of CJS scar formation. Scar formation following CJS in rats is characterized by the activation of fibroblasts caused by early inflammatory stimulation, which leads to the proliferation of collagen and smooth muscle fibers, resulting in scars.

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Section: Discussionmentioning

confidence: 99%

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Lyu¹,

Wang²,

Zhou³

et al. 2021

Ann Transl Med

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“…The RCJS procedure is widely adopted to biliary reconstruction in clinical practice ( Xu et al, 2014 ). However, since the procedure inevitably brings destruction to the function of Oddi’s sphincter, intestinal content and bile reflux have always been a huge problem in spite of the great progress we have made in medical techniques, and recurring cholangitis caused by intestinal fluid reflux will cause scar hyperplasia, eventually resulting in CJS stenosis and even canceration ( Asano et al, 2016 ; Dimou et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Effect of Combining Anisodamine With Neostigmine on Local Scar Formation Following Roux-en-Y Choledochojejunostomy in a Novel Rat Model

Lyu

Wang

et al. 2021

Front. Pharmacol.

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Background: The present study aimed to explore the potential effect of combining anisodamine with neostigmine on local scar formation following Roux-en-Y choledochojejunostomy (RCJS) in a novel rat model.Methods: The biliary obstruction model of Sprague Dawley (SD) rats was established in advance, and 54 rats were divided into nine groups randomly (sham operation group, anisodamine group, neostigmine group, combination group, and control group). Anisodamine (25 mg/kg) and neostigmine (50 μg/kg) were injected to the abdominal cavity separately or simultaneously for 1 week since the first day after surgery according to their allocated intervention, while the same amount of saline (0.5 ml) was injected intraperitoneally in the control group. Indexes including body weight, the diameter of the common bile duct, liver function, inflammatory indexes, and the condition of scar formation in different groups at certain time were evaluated in our study.Results: Recovery of liver function (ALT, AST, TB, DB, and GGT) and systematic inflammation indexes (CRP, TNF-α, and IL-1β) in the combination group was prior to that in the control group (p < 0.05), while no statistical difference in the serum level of IL-10 was observed among groups. Rats in the combination group represented a wider anastomotic diameter and lower expression of α-SMA and TGF-β1 at anastomotic stoma compared to the control group (p < 0.05). Histopathological staining showed slighter proliferation of collagen and smooth muscle fibers in rats’ bile duct wall and less local scar formation at anastomotic stoma compared to the control group.Conclusion: The combination of anisodamine and neostigmine can alleviate local and systemic inflammatory response, promote the recovery of liver function, and reduce scar formation in rats after the RCJS procedure.

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“…The Roux-en-Y were reconstructed by pancreaticojejunostomy with the original stomach-jejunum anastomosis and choledochojejunostomy, described for our previous study. [16] Follow-up Patients were followed up 1 months after the second operation, and thereafter every 6 months with screening for CA19-9 and carcinoembryonic antigen and enhanced computed tomography scans.…”

Section: Second Operationmentioning

confidence: 99%

A modified approach Pancreaticoduodenectomy feasible for recurrent cancer in No. 13 lymph node following gastrectomy

Feng

Zhang

2019

Preprint

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Background In a proportion of patients with recurrence of gastric cancer after surgery, that recurrence is in the No. 13 lymph node group. The treatment of these patients are still controversal and challenging. Here we used a modified ‘Artery-first’ approach technique and retrospective analysis the data to examined the efficacy and feasibility of reoperative pancreaticoduodenectomy for recurrent cancer in this lymph node group after initial subtotal gastrectomy. Methods From January 2011 to December 2015, 24 patients underwent pancreaticoduodenectomy with a modified ‘Artery-first’ approach technique for recurrent gastric cancer in the No. 13 lymph node group at Tongji Hospital, Wuhan, China. Their medical records were retrospectively reviewed for relevant clinical characteristics, type of first and second surgical procedures, TNM stage, adjuvant treatments, complications, and survival. Kaplan–Meier curves were used to analyze survival. Results The median interval between the first and second operations was 7.5 (range 4.5–13.5) months and the median duration of follow-up 20.1 (range 5–58) months. The median operation time was 6.5 (range 5.0–9.9) hours, and median blood loss 448 (range 110–1200) mL. The median intensive care unit stay was 1.5 (range 1–4) days and the median postoperative hospital stay 31.6 (range 15–55) days. No patient died. Two had serious complications. The median survival after pancreaticoduodenectomy was 28 (range 5–58) months. 13 patients had subsequent recurrence. T stage, N stage, and adequacy of resection influenced survival. Conclusion s Pancreaticoduodenectomy with a modified ‘Artery-first’ approach technique is a reasonable treatment option for recurrent remnant gastric cancer following unexpanded lymphadenectomy, particularly for patients with no distant metastases. Additionally, D2+ lymphadenectomy may be more effective than D2 lymphadenectomy in patients with locally advanced gastric cancer.

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A new approach for Roux-en-Y reconstruction after pancreaticoduodenectomy

Cited by 6 publications

References 31 publications

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Therapeutic Effect of Combining Anisodamine With Neostigmine on Local Scar Formation Following Roux-en-Y Choledochojejunostomy in a Novel Rat Model

A modified approach Pancreaticoduodenectomy feasible for recurrent cancer in No. 13 lymph node following gastrectomy

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