Wu Jian-Zhong, Orita Hajime, Zhang Shun, Egawa Hiroyuki, Yube Yukinori, Kaji Sanae, Oka Shinichi, Fukunaga Tetsu
Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Juntendo University, Tokyo 1638001, Japan.
World J Gastrointest Surg. 2020 Aug 27;12(8):346-354. doi: 10.4240/wjgs.v12.i8.346.
Laparoscopic distal gastrectomy (LDG) for gastric cancer has been progressed and popular in Japan, since it was first described in 1994. Several reconstruction methods can be adopted according to remnant stomach size, and balance of pros and cons. Roux-en-Y (R-Y) reconstruction is a one of standard options after LDG. Its complications include Petersen's hernia and Roux stasis syndrome. Here we report our ingenious attempt, fixation of Roux limb and duodenal stump, for decreasing the development of Petersen's hernia and Roux stasis syndrome.
To develop a method to decrease the development of Petersen's hernia and Roux stasis syndrome.
We performed ante-colic R-Y reconstruction after LDG. After R-Y reconstruction, we fixed Roux limb onto the duodenal stump in a smooth radian. this small improvement in Roux limb, Roux limb was placed to the right of the ligament of Treitz. This not only changed the anatomy of the Petersen's defect, but it also kept a fluent direction of gastrointestinal anastomosis and avoided a cross-angle after jejunojejunostomy. 31 patients with gastric cancer was performed this technique after R-Y reconstruction. Clinical parameters including clinicopathologic characteristics, perioperative outcomes, postoperative complication and follow-up data were evaluated.
The operative time was (308.0 ± 84.6 min). This improvement method took about 10 min. Two (6.5%) patients experienced pneumonia and pancreatitis, respectively. No patient required reoperation or readmission. All patients were followed up for at least 3 year, and none of the patients developed postoperative complications related to internal hernia or Roux stasis syndrome.
This 10 min technique is a very effective method to decrease the development of Petersen's hernia and Roux stasis syndrome in patients who undergo LDG.
自1994年首次描述以来，腹腔镜远端胃癌切除术（LDG）在日本得到了发展并广泛应用。根据残胃大小及利弊权衡可采用多种重建方法。Roux-en-Y（R-Y）重建是LDG术后的标准选择之一。其并发症包括彼得森疝和Roux滞留综合征。在此，我们报告我们为减少彼得森疝和Roux滞留综合征的发生所做的巧妙尝试，即固定Roux袢和十二指肠残端。
开发一种减少彼得森疝和Roux滞留综合征发生的方法。
我们在LDG术后进行结肠前R-Y重建。R-Y重建后，我们将Roux袢以平滑弧度固定于十二指肠残端。在这个对Roux袢的微小改进中，Roux袢置于Treitz韧带右侧。这不仅改变了彼得森缺损的解剖结构，还保持了胃肠吻合的流畅方向，避免了空肠空肠吻合后的交叉角。31例胃癌患者在R-Y重建后采用了该技术。对包括临床病理特征、围手术期结果、术后并发症和随访数据在内的临床参数进行了评估。
手术时间为（308.0±84.6分钟）。这种改进方法耗时约10分钟。两名（6.5%）患者分别发生了肺炎和胰腺炎。没有患者需要再次手术或再次入院。所有患者至少随访3年，且无一例患者发生与内疝或Roux滞留综合征相关的术后并发症。
这种耗时10分钟的技术是减少接受LDG患者发生彼得森疝和Roux滞留综合征的非常有效的方法。
