Abstract:

Objective

To explore the influence of different anastomosis techniques on patients undergoing laparoscopic radical distal gastrectomy.

Methods

The data of 110 patients who underwent laparoscopic radical distal gastrectomy from September 2022 to April 2023 were retrospectively analyzed.According to different anastomosis methods，they were divided into the non-transection group （undergoing nontransection Roux-en-Y anastomosis） and the Billroth II group （undergoing Billroth II + Braun anastomosis）.Propensity matching was used to exclude confounding factors in the baseline data，and 55 patients were obtained in each group.The SPSS22.0 software was used for data analysis.Count data such as postoperative complications and the situation of reflux were expressed as［ cases （%）］，and the χ² test or Rank Sum test was performed.Measurement data such as perioperative indexes，intestinal barrier indexes，and survival periods were expressed as （±s），and the independent sample t test was carried out.A P value less than 0.05 indicated a statistically significant difference.

Results

The operation time and intraoperative blood loss of patients in the non-transection group were significantly higher than those in the Billroth II group （P＜0.05）.There was no statistically significant difference in the complication rate between the non-transection group （3.6%） and the Billroth II group （12.7%） （P＞0.05）.Three days after surgery，the levels of D-lactic acid and diamine oxidase（DAO），which were indexes of intestinal barrier function，increased significantly in both groups （P＜0.05），and the levels in the non-transection group were significantly higher than those in the Billroth II group （P＜0.05）.The situations of bile reflux and reflux gastritis in patients of the non-transection group were significantly better than those in the Billroth II group （P＜0.05）.After 1-year follow-up，there were no statistically significant differences in the progression-free survival （PFS） between the two groups （Log-Rankχ²=0.529，P=0.467）and in the overall survival （OS） between the two groups （Log-Rankχ²=0.339，P=0.560）.

Conclusion

Both non-transection Roux-en-Y anastomosis and Billroth II + Braun anastomosis can effectively reconstruct the digestive tract of patients undergoing laparoscopic radical distal gastrectomy.Non-transection Roux-en-Y anastomosis has more advantages in aspects such as improving gastrointestinal function and anti-reflux.

Key words: Stomach Neoplasms, Gastrectomy, Uncut Roux-en-Y Anastomosis, Billroth II Anastomosis, Braun Anastomosis, Postoperative Complications