Innovative gastrojejunostomy reconstruction using the pants-shaped anastomosis technique following laparoscopy-assisted distal gastrectomy for gastric cancer.

Abstract

BackgroundThere are many types of gastrojejunostomy reconstruction after laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer, each of which has merit and demerit.ObjectiveIn order to reduce the incidence of postoperative complications after LADG, we designed a novel method-the "Pants-shaped" anastomosis that involves the gastrojejunostomy anastomosis and evaluated its clinical application effect.MethodsIn this retrospective study, data of 630 cases of laparoscopy-assisted distal gastrectomy performed in the First Affiliated Hospital of Wannan Medical College from January 2018 to December 2022 were analyzed. The cases were divided into three groups: "Pants-shaped" anastomosis group (n = 127), Billroth II anastomosis group (n = 242), and Billroth II + Braun anastomosis group (n = 261) according to the different types of gastrojejunostomy reconstruction.ResultsThe laparoscopic operations of all 630 patients were successfully performed. There were no significant differences in intraoperative blood loss, the number of lymph nodes, and complications among the three groups (P > 0.05). The "Pants-shaped" group resulted in shorter time to first flatus (P = 0.004), shorter postoperative time (P = 0.008), longer anastomosis time (P < 0.05), and lower hospitalization costs (P < 0.05) than the Billroth II group; and shorter operation time and shorter postoperative time (P = 0.008), and lower hospitalization costs (P < 0.05) than the Braun group. There were significant statistical differences in the early postoperative complications among the three groups (P > 0.05). The "Pants-shaped" group showed less reflux gastritis (P = 0.022) in the postoperative 5 years follow-up compared to the Billroth II group.ConclusionThe procedure of "Pants-shaped" anastomosis is safe and feasible, which can be easily performed. It can be a good option with shorter postoperative time and less reflux gastritis.