title: Retrocolic roux-en-Y anastomosis for total laparoscopic distal gastrectomy: fix-the-remnant-first technique.
abstract: BACKGROUND
  Herein we report our retrocolic Roux-en-Y anastomosis for laparoscopic distal gastrectomy and its feasibility.
  
  
  METHODS
  After laparoscopic distal gastrectomy with lymphadenectomy, the gastric remnant was fixed through the mesentery of the transverse colon. The gastrojejunostomy was performed with linear stapling devices at an angle that allowed for easy application. The jejunojejunostomy was also performed with linear stapling devices. All spaces between the mesentery were hand-sewn closed. This procedure was performed laparoscopically without additional incisions in all 34 patients. The median operative time was 365 min and the median blood loss was 50 mL. All patients started liquid intake the day after gastrectomy. There were three cases of Grade 1 complications and one Grade 2 complication per the Clavien-Dindo Classification. Patients' weights after surgery were stable at the 36-month follow-up.
  
  
  CONCLUSIONS
  The advantages of Roux-en-Y reconstruction have been reported to include less frequent anastomotic leakage, less gastritis and less bile reflux over the long term. The retrocolic reconstructions were performed in a manner similar to open surgery but under a laparoscopic view. The mesentery closure stitches to prevent internal herniation did not require as many stitches as the antecolic route and were easier to place. Our anastomosis for laparoscopic distal gastrectomy showed acceptable short-term results, with patients maintaining up to 91.0% of their preoperative weight and nutritional input. By fixing the remnant stomach to the mesentery of the transverse colon before the anastomosis, we easily completed the retrocolic Roux-en-Y anastomosis under laparoscopic view.
authors.affiliation: Department of Gastroenterological Surgery, University of Fukui, Fukui, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Iida
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hirono
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fujimoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Koneri
authors.forename: Takanori
authors.initials: T
authors.lastname: Goi
authors.forename: Kanji
authors.initials: K
authors.lastname: Katayama
authors.forename: Akio
authors.initials: A
authors.lastname: Yamaguchi
mesh_terms: D000005:Abdomen; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Laparoscopic gastrectomy; Roux-en-Y reconstruction; retrocolic reconstruction