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Roux Stasis Syndrome and Gastric Food Stasis After Laparoscopic Distal Gastrectomy with Uncut Roux-en-Y Reconstruction in Gastric Cancer Patients: A Propensity Score Matching Analysis

Authors
Park, YS; Shin, DJ; Son, SY; Kim, KH; Park, DJ; Ahn, SH; Park, DJ; Kim, HH
Citation
World journal of surgery, 42(12):4022-4032, 2018
Journal Title
World journal of surgery
ISSN
0364-23131432-2323
Abstract
BACKGROUND: Uncut Roux-en-Y gastrojejunostomy (uRYGJ) was developed to prevent slow peristalsis in the Roux limb after Roux-en-Y gastrojejunostomy (RYGJ). This study compared the incidence of Roux stasis syndrome (RSS) and severe gastric food stasis in gastric cancer patients who underwent RYGJ or uRYGJ after laparoscopic curative distal gastrectomy.
METHODS: Between January 2006 and June 2012, 319 patients underwent RYGJ or uRYGJ. After covariates were adjusted by propensity score matching, 39 patients in the RYGJ group and 65 patients in the uRYGJ group were included in the final analysis. RSS was defined as the presence of symptoms, such as nausea, vomiting, and abdominal fullness, requiring refasting without ileus or obstruction within 30 days post-surgery. Gastric food stasis was measured endoscopically at 1 and 3 years after gastrectomy.
RESULTS: Operative outcomes and morbidities were similar between the two groups, whereas the incidence of RSS was higher in the RYGJ group than in the uRYGJ group, although the difference was not significant (7.7 vs. 0%; odds ratio (OR) 0.157; 95% confidence interval (CI) 0-1.059, p = 0.111). Comparison of endoscopic findings revealed that severe gastric stasis 1 year after surgery was significantly less frequent in the uRYGJ group (46.2 vs. 13.8%; OR 0.247; 95% CI 0.102-0.599, p = 0.002). The same result was reproduced 3 years after surgery (39.4 vs. 15.5%; OR 0.279; 95% CI 0.088-0.882, p = 0.030).
CONCLUSIONS: Compared with RYGJ, uRYGJ after laparoscopic distal gastrectomy is a safe and effective procedure for preventing severe postoperative gastric food stasis.
MeSH terms
AgedAnastomosis, Roux-en-Y/adverse effects*FemaleGastrectomy/adverse effects*Gastroenterostomy/adverse effects*Gastroparesis/prevention & control*HumansLaparoscopy/adverse effects*MaleMiddle AgedPostoperative Complications/prevention & control*Propensity Score*Stomach Neoplasms/surgery*
DOI
10.1007/s00268-018-4715-6
PMID
29915987
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
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