Randomized controlled trial of uncut Roux-en-Y vs Billroth II reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis?

Abstract

AIMTo identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and Billroth II reconstruction.METHODSA total of 158 patients who underwent laparoscopy-assisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University (Changchun, China) between February 2015 and February 2016 were randomized into two groups: uncut Roux-en-Y (group U) and Billroth II group (group B). Postoperative complications and relevant clinical data were compared between the two groups.RESULTSAccording to the randomization table, each group included 79 patients. There was no significant difference in postoperative complications between groups U and B (7.6% vs 10.1%, P = 0.576). During the postoperative period, group U stomach pH values were lower than 7 and group B pH values were higher than 7. After 1 year of follow-up, group B presented a higher incidence of biliary reflux and alkaline gastritis. However, histopathology did not show a significant difference in gastritis diagnosis (P = 0.278), and the amount of residual food and gain of weight between the groups were also not significantly different. At 3 mo there was no evidence of partial recanalization of uncut staple line, but at 1 year the incidence was 13%.CONCLUSIONCompared with Billroth II reconstruction, uncut Roux-en-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn. Despite the incidence of recanalization, uncut Roux-en-Y should be widely applied.

Optimal reconstruction methods after distal gastrectomy for gastric cancer

“…A total of 399 articles considered to be potentially relevant were identified from various databases including PubMed, EMBASE (Ovid), and Cochrane Library (Ovid), 9 studies [ 19 – 27 ] meeting the inclusion criteria were included in this meta-analysis. Literatures screening process is shown in Fig.…”

Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis

“…Hence, U-RY reconstruction could prevent reflux gastritis and esophagitis. The U-RY reconstruction could effectively prevent delayed gastric emptying and Roux stasis syndrome by preserving jejunum continuity, integrity of myoelectrical conduction, direction of muscle contraction in the gastrointestinal tract, and normal intestinal peristalsis[ 30 , 31 ]. No significant difference was found in anastomosis-related complications between the two groups.…”

“…Related studies[ 25 - 28 ] reported the occurrence of recanalization at the site of afferent closure after U-RY reconstruction, which may increase the incidence of alkaline reflux gastritis and esophagitis and decrease quality of life. Yang et al[ 31 ] concluded in their study that the incidence of partial recanalization after U-RY reconstruction reached 13.0%. In the included literature, three articles mentioned the problem of recanalization of the obliterated afferent jejunal limb.…”

Isoperistaltic versus antiperistaltic uncut Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a propensity score matched analysis

“…URYA can divert biliary and pancreatic secretions away from the remnant stomach more efficiently by blocking the afferent loop and further prevent inflammation and even carcinogenesis of the remnant stomach and esophagus [ 3 – 5 , 20 , 21 ]. However, the recanalization of the jejunum after surgery may nullify this benefit.…”