title: Roux-en-Y reconstruction at greater curvature in biliopancreatic diversion: effects on early postoperative functional recovery.
abstract: Delayed gastric emptying after distal gastrectomy and reconstruction of alimentary tract with a gastroenteric anastomosis can significantly influence early and late postoperative course and the length of hospital stay. The purpose of this study was to compare the effect on postoperative functional recovery of two different Roux-en-Y reconstructions: at the gastric greater curvature and at the transected gastric staple line in the Scopinaro's biliopancreatic diversion. We conducted comparative study; 80 patients were enrolled and divided in two groups: group A (RY-GC) and group B (RY-SL) with 40 patients in each group. We compared the early postoperative functional recovery for both groups measuring four parameters: gastric stasis indicated with the volume of the gastric fluid collected per 24 h, day of removal of the nasogastric tube, day of starting the oral intake, and day of hospital discharge. There was statistically significant (p < 0.001) reduction in gastric fluid volume in favor of the RY-GC group starting from the first postoperative day resulting in earlier removal of nasogastric tube with earlier starting of oral feeding than RY-SL group, with no symptoms of stasis required nutrition suspension; while three patients in RY-SL group experienced persistence of nausea and vomiting and needed nutrition suspension for several days. There was statistically significant (p < 0.001) reduction in the hospital stay for RY-GC group. Roux-en-Y reconstruction at the greater curvature ensures a rapid functional recovery with early hospital discharge. The use of stapler devices made this method easier and safer and no complications have arisen with mechanical anastomoses.
authors.affiliation: Piliclinico Polispecialistico Multimedica, Milan, Italy. valerio.ceriani@multimedica.it
authors.forename: Valerio
authors.initials: V
authors.lastname: Ceriani
authors.forename: Tiziana
authors.initials: T
authors.lastname: Lodi
authors.forename: Andrea
authors.initials: A
authors.lastname: Porta
authors.forename: Oscar
authors.initials: O
authors.lastname: Roncaglia
authors.forename: Chiara
authors.initials: C
authors.lastname: Osio
authors.forename: Edoardo
authors.initials: E
authors.lastname: Faleschini
authors.forename: Paola
authors.initials: P
authors.lastname: Bignami
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Coladonato
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elnabil-Mortada
authors.forename: Annalisa
authors.initials: A
authors.lastname: Belloni
authors.forename: Daniela
authors.initials: D
authors.lastname: Baldoli
authors.forename: Paolo
authors.initials: P
authors.lastname: Gaffuri
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000295:instrumentation / Q000379:methods*; D015904:Biliopancreatic Diversion; D004435:Eating; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation / Q000379:methods*; D018589:Gastroparesis / Q000453:epidemiology; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D020127:Recovery of Function; D016037:Single-Blind Method; D013270:Stomach / Q000601:surgery; D013537:Sutures