Kamada Teppei, Ohdaira Hironori, Hoshimoto Sojun, Narihiro Satoshi, Suzuki Norihiko, Marukuchi Rui, Takeuchi Hideyuki, Yoshida Masashi, Yamanouchi Eigoro, Suzuki Yutaka
Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
Department of Radiology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
Surg Case Rep. 2020 May 24;6(1):108. doi: 10.1186/s40792-020-00871-4.
Small bowel obstruction after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction) is not a rare complication. However, patients who need re-operation for this complication have a high rate of postoperative complications. We report a case series of three patients who underwent fluoroscopic balloon dilation (FBD) for early jejunojejunostomy obstruction (JJO) after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction).
Three patients were referred to our hospital for surgery for gastric cancer. Robot-assisted distal gastrectomy with D2 lymph node dissection and antecolic R-Y reconstruction were performed in two patients, and robot-assisted total gastrectomy with D1+ lymph node dissection and antecolic R-Y reconstruction was performed in one patient. The jejunojejunostomy was created as a side-to-side anastomosis using a linear 45-mm stapler. The entry hole was closed with a knotless barbed suture, and serosal-muscle layer suture reinforcement with an absorbable suture was performed at the jejunojejunostomy. Subsequently, all the patients were diagnosed with JJO by computed tomography and upper gastrointestinal series. The average time to JJO from gastrectomy was 5 days (range 2-7); initial clinical symptoms were vomiting in all three cases, with simultaneous upper abdominal pain in one case. We successfully performed FBD in all three cases after unsuccessful conservative treatment using an ileus tube. The clinical symptoms improved soon after FBD, and all the patients were able to avoid re-operation. The average period to FBD from JJO was 10 days (range 4-14). The average procedure time was 46 min (range 29-68), and the average duration to oral intake from FBD was 4 days (range 2-5). The average duration of hospital stay after FBD was 12 days (range 9-15). There were no complications in any of the cases.
FBD might be a feasible procedure to avoid surgery for early small bowel obstruction after gastrectomy with R-Y reconstruction.
胃切除术后行Roux-en-Y重建术（R-Y重建）后发生小肠梗阻并非罕见并发症。然而，因该并发症需要再次手术的患者术后并发症发生率较高。我们报告了一组3例患者的病例系列，这些患者在胃切除术后行Roux-en-Y重建术（R-Y重建）后发生早期空肠空肠吻合口梗阻（JJO），接受了透视下球囊扩张术（FBD）。
3例患者因胃癌被转诊至我院接受手术。2例行机器人辅助远端胃切除术加D2淋巴结清扫及结肠前R-Y重建，1例行机器人辅助全胃切除术加D1+淋巴结清扫及结肠前R-Y重建。空肠空肠吻合采用45mm线性吻合器行侧侧吻合。入口处用免打结倒刺缝线缝合，空肠空肠吻合处用可吸收缝线行浆肌层缝合加固。随后，所有患者均通过计算机断层扫描和上消化道造影诊断为JJO。从胃切除到JJO的平均时间为5天（范围2 - 7天）；所有3例患者的初始临床症状均为呕吐，其中1例同时伴有上腹部疼痛。在使用肠梗阻导管保守治疗失败后，我们成功地对所有3例患者进行了FBD。FBD后临床症状很快改善，所有患者均避免了再次手术。从JJO到FBD的平均时间为10天（范围4 - 14天）。平均手术时间为46分钟（范围29 - 68分钟），FBD后至经口进食的平均时间为4天（范围2 - 5天）。FBD后平均住院时间为12天（范围9 - 15天）。所有病例均无并发症发生。
FBD可能是一种可行的方法，可避免胃切除术后行R-Y重建后早期小肠梗阻的手术治疗。
