Comparison of uncut Roux-en-Y anastomosis and traditional Roux-en-Y anastomosis in the totally laparoscopic distal gastrectomy for gastric cancer: An analysis of multiple centers' data

目的对比非离断式(Uncut)Roux-en-Y吻合和传统Roux-en-Y吻合应用于全腹腔镜远端胃癌根治术后消化道重建的安全性和短期疗效。方法回顾性分析国内10家单位共60例远端胃癌根治术后全腹腔镜消化道重建的胃癌病人临床资料,根据消化道重建方式不同分为Uncut Roux-en-Y组(Uncut组)34例,传统Roux-enY组(传统组)26例。结果 Uncut Roux-en-Y吻合在消化道重建时间方面用时更短[(51.5±13.3)min vs.(80.4±16.2)min,P=0.000],出血量更少[(60.0±35.6)m L vs.(132.9±65.1)m L,P=0.000],且在进食半流饮食时间方面具有优势[(4.6±1.5)d vs.(7.2±2.3)d,P=0.000]。两组病人在留置胃管时间、术后排气时间、进食流质时间和术后住院时间方面差异无统计学意义。两组病人均无围手术期死亡病例,并发症发生率差异无统计学意义(8.8%vs.7.7%,P=0.875)结论 Uncut Roux-en-Y吻合和传统Roux-en-Y吻合应用于全腹腔镜下消化道重建安全可行,Uncut Roux-en-Y吻合在重建时间和控制出血量方面具有优势。Objective To compare the security and short-term effect of the digestive tract reconstruction during the totally laparoscopic distal gastrectomy for gastric cancer between the Uncut Roux-en-Y anastomosis and the traditional Roux- en- Y anastomosis. Methods The clinical data of 60 gastric cancer patients with digestive reconstruction underwent totally laparoscopic distal gastrectomy between December 2012 and June 2015 in 10 domestic hospital were analyzed retrospectively. According to the difference of digestive reconstruction,it can be divided into the Uncut Rouxen-Y anastomosis group with 34 patients and the traditional Roux-en-Y anastomosis group with 26 patients. Results In uncut Roux-en-Y anastomosis group,the operative time in digestive reconstruction was shorter[(51.5±13.3)min vs.(80.4±16.2)min,P=0.000]; the intraoperative blood loss was less[(60.0±35.6)m L vs.(132.9±65.1)m L,P=0.000];semi-liquid diet time was earlier[(4.6±1.5)d vs.(7.2±2.3)d,P=0.000]. However,there was no difference between the two groups on nasogastric tubegastrointestinaltwo groups on nasogastric tube,gastrointestinal transit,fluid diet and the duration of postoperative hospital stay. Both groups had no death case during the perioperative period and there was no significant statistical difference in the postoperative complication rates(8.8% vs. 7.7%,P=0.875).Conclusion The Uncut Roux- en- Y anastomosis and the traditional Roux-en-Y anastomosis are both safe and feasible for the digestive reconstruction under the totally laparoscopic distal gastrectomy for gastric cancer. Besides,the Uncut Roux- en- Yanastomosis has other advantages such as less reconstruction time and less bleeding.广东省科技计划项目(No.2014A020212591

Histological insights into the pathogenesis of post‐Roux‐en‐Y hyperinsulinaemic hypoglycaemia

Background β‐cell hyperplasia has been implicated in the aetiology of post Roux‐en‐Y gastric bypass hyperinsulinaemic hypoglycaemia, but the pathogenesis of this condition is still unclear. Case report We report a case of a 52‐year‐old man with post‐Roux‐en‐Y gastric bypass hyperinsulinaemic hypoglycaemia who underwent distal pancreatectomy to alleviate his symptoms. Pancreatic histopathology showed chronic pancreatitis with a corresponding loss of exocrine tissue and islet retention. Amyloid deposition was found in pancreatic islets. These features are more typically associated with Type 2 diabetes. Discussion This case highlights the potential multifactorial pathogenesis of symptomatic hypoglycaemia after Roux‐en‐Y gastric bypass. What's new? We present a case of a patient with post Roux‐en‐Y hypoglycaemia and pancreatic histology typically associated with diabetes. We show that hyperinsulinaemic hypoglycaemia has a multifactorial aetiology.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109602/1/dme12571.pd

Biliary reconstruction in liver transplant patients with primary sclerosing cholangitis, duct‐to‐duct or Roux‐en‐Y?

IntroductionRoux‐en‐Y choledochojejunostomy and duct‐to‐duct (D‐D) anastomosis are biliary reconstruction methods for liver transplantation. However, there is a controversy over which method produces better results. We have compared the outcome of D‐D anastomosis vs. Roux‐en‐Y hepaticojejunostomy in patients with primary sclerosing cholangitis who had undergone liver transplant in Shiraz Organ Transplant Center.MaterialsThe medical records of 405 patients with primary sclerosing cholangitis (PSC) who had undergone liver transplant from 1996 to 2015 were reviewed. Patients were divided into two groups: Roux‐en‐Y group and D‐D group. Morbidity, disease recurrence, and graft and patient survival rates were compared between the two groups.ResultsTotal of 143 patients underwent a D‐D biliary reconstruction, and 260 patients had a Roux‐en‐Y loop. Biliary complication involved 4.2% of patients from the D‐D group, and 3.9% from the Roux‐en‐Y group (P=. 863). Actuarial 1‐, 3‐, and 5‐year patient survival for D‐D and Roux‐en‐Y group was 92%, 85%, and 74%; and 87%, 83%, and 79%, respectively (P=.384). The corresponding 1‐, 3‐, and 5‐year probability of biliary complication was 97%, 95%, and 92%; and 98%, 97%, and 94%, respectively (P=.61).ConclusionDuct‐to‐duct biliary reconstruction in liver transplantation for selected patients with PSC is a good alternative instead of Roux‐en‐Y biliary reconstruction.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137583/1/ctr12964.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137583/2/ctr12964_am.pd

Excision of choledochal cyst in children by Roux-en-Y hepaticojejunostomy

The aim of this study was to review our experience of total excision with Roux-en-Y hepatico-jejunostomy for the surgical management of type I and type IVa choledochal cysts in 30 children. Among them, 22 were in type I and 8 in type IVa choledochal cysts. All had complete excision and Roux-en-Y hepaticojejunostomy with no morality. Morbidity consisted of prolong drainage (n=2) and late onset cholangitis/pancreatitis (n=4). Choledochal cyst generally has an excellent prognosis with early complete excision and Roux-en-Y hepaticojejunostomy

Subtherapeutic anticoagulation with dabigatran following Roux-en-Y gastric bypass surgery

AbstractWe report a 66-year-old male with a history of Roux-en-Y gastric bypass surgery who began dabigatran for new onset atrial fibrillation. After 5 weeks of therapy, his transesophageal echocardiogram prior to electrocardioversion showed severe spontaneous echo contrast. Cardioversion was postponed and anticoagulant therapy was continued. The following day, he suffered a thromboembolic stroke. Concern arose that postoperative malabsorption could have resulted in subtherapeutic anticoagulation. This notion was strengthened by a second patient who had subtherapeutic serum levels despite maximal dosing. To the best of our knowledge, we are the first to report impaired absorption of dabigatran following Roux-en-Y gastric bypass surgery.<Learning objective: Dabigatran has a predictable pharmacokinetic profile, allowing for a fixed-dose regimen that does not require frequent monitoring or dietary modifications. However, its absorption in patients who have undergone Roux-en-Y gastric bypass surgery has not been studied. Postoperative malabsoprtion, a major complication following Roux-en-Y gastric bypass surgery, can result in inadequate anticoagulation. As a result of unpredictable absorption, strategies allowing for routine monitoring may be best in this population.

Standardization of the Fully Stapled Laparoscopic Roux-en-Y Gastric Bypass for Obesity Reduces Early Immediate Postoperative Morbidity and Mortality: A Single Center Study on 2606 Patients

Various techniques of laparoscopic Roux-en-Y gastric bypass have been described. We completely standardized this procedure to minimize its sometimes substantial morbidity and mortality. This study describes our experience with the standardized fully stapled laparoscopic Roux-en-Y gastric bypass (FS-LRYGB) and its influence on the 30-day morbidity and mortality.status: publishe

“A New Reconstructive Method after Pancreaticoduodenectomy: the Triple Roux on a “P” Loop. Rationale and Radionuclide Scanning Evaluatlon.”

We propose a method of reconstruction after pancreaticoduodenectomy consisting of a double Roux en Y on the same jejunal loop without interruption of the mesentery and a third anatomical Roux en Y to reconstitute the alimentary tract

A valid treatment option for isolated congenital microgastria

Congenital microgastria (CM) is an extremely rare anomaly of the caudal part of the foregut. Treatment of CM has not yet been standardized. We present the case of a 34-monthold girl with an isolated CM complicated by nasogastric tube-related gastric perforation. During the definitive reconstructive surgery, a scarred structure (1.5 1.5 cm) was found to follow a dilated esophagus. The scarred microstomach was resected, and a Roux-en-Y esophagojejunostomy was performed. The patient has been followed for 6 months. She tolerates a regular oral diet and has reached acceptable growth parameters. We describe the first case of CM to be treated with resection of the microstomach and with a Roux-en-Y esophagojejunostomy.Keywords: congenital microgastria, gastrectomy, Roux-en-Y esophagojejunostom

Hepaticoduodenostomy as a technique for biliary anastomosis in children with choledochal cyst: An experience with 31 cases

Objective The aim of this study was to investigate the efficacy and complications of hepaticoduodenostomy in the treatment of choledochal cyst in children. Summary background data The conventional treatment of choledochal cyst includes Roux-en-Y hepaticojejunostomy for biliary reconstruction. This procedure, however, disrupts normal bowel continuity and requires two anastomoses. We studied the technique of hepaticoduodenostomy as an effective alternative to this technique.Patients and methods A total of 31 children undergoing  hepatoduodenostomy for choledochal cyst over a period of 9 years were included in this study.Results The patients operated upon had outcomes similar to those treated by the Roux-en-Y technique in other studies.Conclusion Hepaticoduodenostomy is an effective alternative to the conventional Roux-en-Y anastomotic technique in cases of choledochal cyst in children. Keywords: choledochal cyst, hepaticoduodenostomy, pediatri