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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 > 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

Objective To compare the treatment effects and complications of three reconstruction procedures in patients after radical gastrectomy. Methods A total of 194 patients with radical gastrectomy were selected and divided into the U-RY group (Uncut Roux-en-Y anastomosis, 69 cases), the B Ⅰ group (Billroth-Ⅰ modified delta-shaped anastomosis, 65 cases) and the B Ⅱ +Braun group (Billroth- Ⅱ +Braun anastomosis, 60 cases) according to the gastrointestinal reconstruction methods. The basic data of the three groups were matched by propensity score matching. The surgical status, postoperative recovery status, intestinal barrier function [diamine oxidase (DAO), D-lactic acid, endotoxin (ETX)], inflammatory stress indicators [interleukin-6 (IL-6), interleukin-10 (IL-10), 8-iso-prostaglandin F2α (8-iso-PGF2α), heme oxygenase-1 (HO-1)] and complications were compared between the three groups. Results Before propensity score matching, gender and age were not evenly distributed in the three groups (P＜0.05). After matching, 147 cases of 194 patients were successfully matched, with 49 cases in each group. There were no significant differences in general data between the three groups (P＞0.05). The surgical time increased successively in the B Ⅰ group, the B Ⅱ+Braun group and the U-RY group (P＜0.05). The intraoperative blood loss, postoperative bowel sound recovery time, first exhaust time, extubation time, eating time, first defecation time and hospital stay were less or shorter in the B Ⅰ group than those in the B Ⅱ+Braun group and the U-RY group (P＜0.05), but there were no significant differences in the above indicators between the B Ⅱ+Braun group and the U-RY group (P＞0.05). At 3 d after surgery, the levels of DAO, D-lactic acid and ETX were significantly lower in the B Ⅰ group than those of the U-RY group and the B Ⅱ+Braun group, while the levels of IL-6, IL10, 8-iso-PGF2α and HO-1 were higher compared with those in the U-RY group and the B Ⅱ+Braun group (P＜0.05). There were no significant differences in the above indicators between the U-RY group and the B Ⅱ+Braun group (P＞0.05). There were no significant differences in incidence rates of complications between the three groups (P＞0.05). Conclusion Billroth- Ⅰ modified delta-shaped anastomosis has the advantages of shorter surgical duration, less blood loss, faster recovery and smaller effect on the intestinal barrier compared to Billroth- Ⅱ+Braun anastomosis and Uncut Roux-en-Y anastomosis, but the latter two are more suitable for more indications and have milder inflammatory stimulation, and Uncut Roux-en-Y anastomosis can reduce postoperative reflux. [ABSTRACT FROM AUTHOR]

Abstract Background The uncut Roux-en-y anastomosis (URYA) has some clinical advantages after distal gastrectomy (DG). Little evidence exists regarding the influence of peristalsis on this anastomosis. We aimed to evaluate short-term outcomes of isoperistaltic URYA (iso-URYA) comparing with antiperistaltic URYA (anti-URYA) after DG. Method Patients who underwent URYA for gastric cancer (GC) between January 2016 and December 2018 were selected from Shanghai Changhai Hospital, Navy Medical University. Short-term outcomes were compared between iso-URYA group and anti-URYA group after 1:1 propensity score matching (PSM). Result A total of 612 patients were selected. 392 patients underwent iso-URYA and 220 patients underwent anti-URYA. After PSM, 183 patients for each group were included in the final analysis. No differences were found between them in terms of short-term complications, nutritional status and quality of life 1 year after surgery. Endoscopic examination showed that anti-URYA group had more severe gastritis (P = 0.036). In addition, the recanalization rate was significantly higher when the afferent loop was blocked by stapler. Conclusion The iso-URYA and anti-URYA group present similar results in short term outcomes. Ligation blocking afferent loop leads to lower recanalization rate.

Abstract Background Gastric cancer is the fourth most common malignant disease worldwide, with lower one-third gastric cancer the most common type. Distal gastrectomy with D2 lymph node dissection was recommended as a standard surgery for distal gastric cancer patients. However, some controversy remains about the anastomosis of the residual stomach and the intestine. The objectives of this trial are to test the hypothesis that uncut Roux-en-Y anastomosis can reduce postoperative complications and improve nutritional status more effectively than Billroth II anastomosis in gastric cancer patients after D2 gastrectomy. Methods/design This multi-center, prospective, phase III, randomized controlled trial will compare the efficacy of uncut Roux-en-Y anastomosis versus Billroth II anastomosis in phase I–III patients with initial treatment of radical distal gastrectomy. Patients will be randomized to undergo either the intervention (uncut Roux-en-Y anastomosis) or the control (Billroth II anastomosis). We will recruit 832 patients who meet the trial eligibility criteria and will follow the patients after surgery to observe postoperative complications and nutrition status for 5 years. The primary assessment indices of the study are reflux gastritis, esophagitis, bile regurgitation, and anastomotic ulcer. The secondary assessment indices are nutritional status, quality of life, perioperative complications, overall survival rate, and others. When the number of cases reaches 400, an interim analysis will be performed to identify any evidence of definite superiority of the experimental intervention. Discussion We aim to test the hypothesis that uncut Roux-en-Y anastomosis can reduce postoperative complications and improve nutritional status more than Billroth II anastomosis in gastric cancer patients after D2 gastrectomy. The results of the trial will contribute to the best evidence on which to base the reconstruction of distal gastrectomy. Trial registration Chinese Southern Gastric Cancer Conference CSGC002 Trial. ClinicalTrials.gov, NCT02763878. Registered on 5 May 2016.

Background: The uncut Roux-en-y anastomosis (URYA) has some clinical advantages after distal gastrectomy (DG). Little evidence exists regarding the influence of peristalsis on this anastomosis. We aimed to evaluate short-term outcomes of isoperistaltic URYA (iso-URYA) comparing with antiperistaltic URYA (anti-URYA) after DG.Method: Patients who underwent URYA for gastric cancer (GC) between January 2016 and December 2018 were selected from Shanghai Changhai Hospital, Navy Medical University. Short-term outcomes were compared between iso-URYA group and anti-URYA group after 1:1 propensity score matching (PSM).Result: A total of 612 patients were selected. 392 patients underwent iso-URYA and 220 patients underwent anti-URYA. After PSM, 183 patients for each group were included in the final analysis. No differences were found between them in terms of short-term complications, nutritional status and quality of life 1 year after surgery. Endoscopic examination showed that anti-URYA group had more severe gastritis (P = 0.036). In addition, the recanalization rate was significantly higher when the afferent loop was blocked by stapler.Conclusion: The iso-URYA and anti-URYA group present similar results in short term outcomes. Ligation blocking afferent loop leads to lower recanalization rate. [ABSTRACT FROM AUTHOR]

Aims. We have established a procedure for uncut Roux-en-Y gastrojejunostomy after laparoscopic distal gastrectomy. This study aimed to evaluate the safety and technical feasibility of the procedure for patients with distal gastric cancer according to the short-term outcomes. Methods. Two hundred and twenty-eight consecutive patients who underwent a laparoscopic distal gastrectomy with uncut Roux-en-Y gastrojejunostomy from September 2014 to August 2018 were reviewed retrospectively. All the laparoscopic operations were performed successfully without conversion to open surgery. Results. The mean operative duration was 178.28 ± 32.82 minutes, the mean anastomotic process duration was 28.22 ± 7.50 minutes, the average blood loss was 48.97 ± 29.16 mL, and the overall number of lymph nodes harvested was 37.16 ± 11.47. The mean time of out-of-bed ambulation, anal exsufflation, liquid-diet intake, and duration of hospital stay were 41.99 ± 18.37 hours, 69.57 ± 23.17 hours, 5.06 ± 1.09 days, and 8.77 ± 2.42 days, respectively. Fifteen patients suffered postoperative complications, and the overall incidence rate was 6.58% (15/228). Seventeen patients experienced afferent recanalization, the mean time of which was 11 months after the operation. Conclusion. The laparoscopic uncut Roux-en-Y reconstruction is safe and technically feasible, and it has inspiring short-term outcomes for patients undergoing distal gastrectomy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the safety and feasibility of totally laparoscopic uncut Roux-en-Y anastomosis in the distal gastrectomy with D2 dissection for gastric cancer. We also summarized the preliminary experience of totally laparoscopic uncut Roux-en-Y anastomosis.Methods: A retrospective analysis was done in 51 cases of total laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D2 dissection for gastric cancer in our hospital from September 2014 to December 2015.Results: All of 51 cases underwent total laparoscopic uncut Roux-en-Y anastomosis. All the procedures were performed successfully. There were neither conversions to open surgery nor intraoperative complications in all 51 cases. In this study, the median operative time was 170 (135-210) min and the median time of anastomosis was 27 (24-41) min. The blood loss was 60 (30-110) ml. The time to flatus and length of postoperative hospital stay were 2 (1-3) days, and 8 (7-12) days, respectively. The mean lymph node harvest was 34 (18-49). One anastomotic bleeding occurred postoperatively which was cured by conservative treatment. No major postoperative complication occurred, such as anastomotic leak, anastomotic stenosis, and Roux stasis syndrome. After a short-term follow-up, no recanalization or reflux gastritis was encountered by endoscopy.Conclusion: The totally laparoscopic uncut Roux-en-Y anastomosis in distal gastrectomy with lymph node dissection for gastric cancer is safe and feasible, with a very low rate of recanalization and reflux gastritis. [ABSTRACT FROM AUTHOR]

Objectives: This study discusses and analyzes the effects of uncut Roux-en-Y anastomosis on the postoperative complications and quality of life of gastric cancer patients after they undergo laparoscopic total gastrectomies., Methods: 86 patients admitted to our hospital for laparoscopic digestive tract reconstruction after distal gastrectomies were recruited as the study cohort and divided into group A (n=41) or group B (n=45) on the basis of the different digestive tract reconstruction surgery each patient underwent. The group-A patients underwent traditional Roux-en-Y anastomosis, and the group-B patients underwent uncut Roux-en-Y anastomosis. The operation outcomes, the early and late postoperative complications, the decline in the postoperative nutrition status, and the changes in the postoperative quality of life scores were compared between the two groups., Results: The intraoperative anastomosis times and the blood losses, the postoperative ventilation, the liquid food intake times, and the hospitalization durations in group B were lower than they were in group A ( P<0.05 ). The incidences of early and late postoperative complications in group A was significantly higher than they were in group B ( P<0.05 ). The decrease of the TP, ALB, and Hb levels in group B was dramatically lower than it was in group A at 6 months after the surgeries ( P<0.05 ), and no significant difference in the TP, ALB, or Hb levels was observed between the two groups at 12 months after the surgeries ( P>0.05 ). The QOL scores in the two groups of patients were increased at 6 and 12 months after the surgeries compared with 1 month after the surgeries ( P<0.05 ). The QOL scores in group B were notably higher than they were in group A at 6 and 12 months after the surgeries ( P<0.05 )., Conclusion: Uncut Roux-en-Y anastomosis after laparoscopic total gastrectomy is simple to carry out. The method can promote patients' early postoperative recovery, reduce their early and late complications, and maintain their postoperative nutritional status, thus improving their postoperative quality of life, so it is worthy of clinical promotion., Competing Interests: None., (AJTR Copyright © 2021.)

Uncut Roux-en-Y anastomosis is widely used in gastrointestinal reconstruction procedure after radical gastrectomy for distal gastric cancer. However, the proximal jejunal closure point recanalization of the input loop is an important complication of postoperative patients with prolonged time, resulting in pancreatic juice or bile reflux, which can lead to inflammatory lesions of the remnant stomach or esophagus. Poor selection of the location of the closure point during anastomosis causes a large amount of food deposited in the blind loop to be pushed and impacted, resulting in loosened threads or failed U-shaped staples, which may cause recanalization complications. Most scholars believe that the shortening of the jejunal tube closure point to the optimal position of 2 to 3 cm from the residual gastrojejunostomy can significantly reduce food retention, decrease the pressure of the closure point and the incidence of recanalization. At present, the application of new anastomotic techniques and materials such as four-row and six-row U-shaped staples and 7# wire ligation under laparoscopy can prevent the occurrence of recanalization of the closure point. Uncut Roux-en-Y anastomosis is safe and has few complications, and is expected to become one of the best ways of digestive tract reconstruction.

Background: Gastric cancer is the fourth most common malignant disease worldwide, with lower one-third gastric cancer the most common type. Distal gastrectomy with D2 lymph node dissection was recommended as a standard surgery for distal gastric cancer patients. However, some controversy remains about the anastomosis of the residual stomach and the intestine. The objectives of this trial are to test the hypothesis that uncut Roux-en-Y anastomosis can reduce postoperative complications and improve nutritional status more effectively than Billroth II anastomosis in gastric cancer patients after D2 gastrectomy.Methods/design: This multi-center, prospective, phase III, randomized controlled trial will compare the efficacy of uncut Roux-en-Y anastomosis versus Billroth II anastomosis in phase I-III patients with initial treatment of radical distal gastrectomy. Patients will be randomized to undergo either the intervention (uncut Roux-en-Y anastomosis) or the control (Billroth II anastomosis). We will recruit 832 patients who meet the trial eligibility criteria and will follow the patients after surgery to observe postoperative complications and nutrition status for 5 years. The primary assessment indices of the study are reflux gastritis, esophagitis, bile regurgitation, and anastomotic ulcer. The secondary assessment indices are nutritional status, quality of life, perioperative complications, overall survival rate, and others. When the number of cases reaches 400, an interim analysis will be performed to identify any evidence of definite superiority of the experimental intervention.Discussion: We aim to test the hypothesis that uncut Roux-en-Y anastomosis can reduce postoperative complications and improve nutritional status more than Billroth II anastomosis in gastric cancer patients after D2 gastrectomy. The results of the trial will contribute to the best evidence on which to base the reconstruction of distal gastrectomy.Trial Registration: Chinese Southern Gastric Cancer Conference CSGC002 Trial. ClinicalTrials.gov, NCT02763878 . Registered on 5 May 2016. [ABSTRACT FROM AUTHOR]