Roux stasis syndrome occurs in 10-25 % of patients after distal gastrectomy with Roux-en Y (RY) reconstruction. Aim of the present study was to study clinical results of uncut RY reconstruction, proposed to eliminate Roux stasis, after distal gastrectomy for gastric cancer. Patients and
Methods: Thirteen patients with gastric cancer underwent distal gastrectomy with uncut RY reconstruction. Briefly, after distal stomach was removed, a side-to-side gastrojejunostomy was performed by anastomosing greater curvature of the remnant stomach and the jejunum 35 cm distal to the ligament of Treitz in an isoperistaltic direction. A side-to-side jejunojejunostomy was performed between the jejunum 20 cm distal to the ligament of Treitz and the jejunum 40 cm distal to the gastrojejunostomy. Finally, the jejunum 3 cm proximal to the gastrojejunostomy was enterically closed using ‘knifeless’ linear stapler. Transmural silk stitches were added around the staples to prevent the dislocation of the staples.
Results: There were 9 male and 5 female patients, and their mean age was 65 (range: 47-88) years. Clinical stages according to Japanese classification of gastric carcinoma were IA for 4, IB for 7, and II for 2 patients. Degree of lymph node dissection according to Japanese classification of gastric carcinoma was D1+α for 2, D1+β for 4, and D2 for 7 patients. As additional procedures, cholecystectomy was carried out in 3 patients, and resection of the rectum for rectal cancer was done in 1 patient. Mean operative time and intraoperative blood loss were 246 (range: 157-452) minutes and 381 (range: 185-895) ml, respectively. Mean time until start of normal diet was 8.7 (range: 6-22) days, and mean time of postoperative hospital stay was 16.2 (range: 9-42) days. Morbidity was observed in three patients (aspiration pneumonia, delayed gastric emptying with nausea and vomiting, and leakage of the duodenal stump). Re-canalization of the jejunum at enterically closed site was investigated endoscopically or fluoroscopically; 2 patients had re-canalization, 6 patients were free from re-canalization, and remaining 5 patients are scheduled to undergo endoscopic examination. Two patients having re-canalization did not complain of symptoms associated with re-canalization. Conlusions: These results indicate that uncut RY after distal gastrectomy was a safe procedure. Re-canalization of enterically closed portion did not cause specific symptoms associated with re-canalization.