Double Tract vs. Roux-en-Y Reconstruction in the treatment of Gastric Cancer

Abstract

Objective:Functional outcomes were prospectively compared between the standard Roux-en-Y and Double-tract reconstruction following a total gastrectomy and D2 lymphadenectomy.Methods:One hundred ten patients with gastric cancer were divided into two groups by the type of reconstruction. Age, gender, T stage, AJCC stage, length of operation, BMI (body mass index, kg/m2), time to soft diet, postoperative leakage of the esophagojejunostomy (EJS), stricture of the EJS, meal intake, and quality of life (QOL) were recorded.Results:The mean age in the R-Y group was 61.57, with the SD of 9.53, while in the DT group the mean age was 60.17 with a SD of 9.92. The BMI decline in the R-Y group was 4.09 with a SD of 1.11, while in the DT group it was 2.85 with a SD of 1.27. We found a highly significant statistical difference between the two groups in the rate of the BMI decline (p<0,001). We found no statistically significant difference regarding QOL between the two groups, p>0.05.Conclusions:The Double tract reconstruction is a simple procedure and the rate of the BMI decline is much smaller compared to the Roux-en-Y group.

Application of double layered end-to-end anastomosis with continuous manual suture for completing digestive tract reconstruction in totally laparoscopic distal gastrectomy

“…At present, various anastomotic methods have their own advantages and disadvantages. For patients with lower gastric cancer, most of them undergo delta-shaped anastomosis, Billroth II anastomosis or Roux-en-Y anastomosis with a stapler [ 1 , 7 , 8 ]. Billroth I anastomosis is considered to be more in line with human physiology and anatomy, so it has been favour by surgeons.…”

“…Roux-en-Y anastomosis requires two anastomoses, thus increasing the number of intestinal stumps, and requires rather complicated steps. Additionally, similar to Billroth II anastomosis, Roux-en-Y anastomosis does not highly conform to human physiology and anatomy [ 8 , 12 ]. If postoperative complications of biliary tract diseases such as bile duct stones occur, ERCP and other tests cannot be performed.…”

Application of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy

“…At present, various anastomotic methods have their own advantages and disadvantages. For patients with lower gastric cancer, most of them underwent Delta-shaped anastomosis, Billroth II anastomosis or Roux-en-Y anastomosis by stapler [1,7,8] . The Billroth I anastomosis is considered to be more in line with the human physiology and anatomy, so it has been favored by surgeons.…”

“…Roux-en-Y anastomosis requires two anastomoses, and thus increases the number of intestinal stumps, which requires rather complicated steps. Also, like Billroth II anastomosis, Roux-en-Y anastomosis does not highly conform to the human physiology and anatomy [8,12]…”

Double-tract reconstruction for oesofagocardial gastric cancer: A systematic review

“…This method involves the replacement of the removed part of the oesophagus and stomach by the isoperistaltic jejunum loop with sequential anastomotic formation between the oesophagus, stomach, and afferent limb of the jejunum [ 17 ]. During proximal gastrectomy (PG), the key features of this technique are resection of the oesophagus and stomach with the transection of the jejunum loop at 20–25 cm from the ligament of Treitz with sequential formation of oesophagoenteroanastomosis and gastroenteroanastomosis with the remaining part of the stomach, followed by entero-entero anastomosis for the reconstruction of the small bowel passage [ 18 ].…”