Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2020; 12(8): 346-354
Published online Aug 27, 2020. doi: 10.4240/wjgs.v12.i8.346
Easy fixation effects the prevention of Peterson’s hernia and Roux stasis syndrome
Jian-Zhong Wu, Hajime Orita, Shun Zhang, Hiroyuki Egawa, Yukinori Yube, Sanae Kaji, Shinichi Oka, Tetsu Fukunaga
Jian-Zhong Wu, Hajime Orita, Shun Zhang, Hiroyuki Egawa, Yukinori Yube, Sanae Kaji, Shinichi Oka, Tetsu Fukunaga, Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Juntendo University, Tokyo 1638001, Japan
Jian-Zhong Wu, Department of Gastroenterology Surgery, Suzhou Ninth People’s Hospital, Nantong University, Suzhou 215000, Jiangsu Province, China
Shun Zhang, Department of Surgery, Tongji University, Shanghai 200000, China
Author contributions: Fukunaga T, Wu JZ and Oka S designed the research; Kaji S, Wu JZ, Zhang S and Yube Y collected the clinical data; Yube Y and Egawa H analyzed the data; Wu JZ and Orita H wrote the paper; Fukunaga T corrected and approved the manuscript.
Institutional review board statement: This study was retrospective, and no interference with patients’ treatment was made. Thus, the approval by the Institutional Review Committee of Juntendo University Hospital was waived.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tetsu Fukunaga, MD, PhD, Professor, Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 1138431, Japan. t2fukunaga@juntendo.ac.jp
Received: May 2, 2020
Peer-review started: May 2, 2020
First decision: May 24, 2020
Revised: May 31, 2020
Accepted: July 26, 2020
Article in press: July 26, 2020
Published online: August 27, 2020
Processing time: 111 Days and 8.9 Hours
Abstract
BACKGROUND

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.

AIM

To develop a method to decrease the development of Petersen’s hernia and Roux stasis syndrome.

METHODS

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. Via 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.

RESULTS

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.

CONCLUSION

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.

Keywords: Laparoscopy distal gastrectomy; Roux-en-Y reconstruction; Internal hernia; Roux limb syndrome; Gastric cancer

Core tip: We developed a method, fixation of Roux limb and duodenal stump. 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. None of the patients had complications related to Petersen’s hernia and Roux stasis syndrome by at least three years of follow-up in this study. This technique is a simple and effective method to decrease the development of Petersen’s hernia and Roux stasis syndrome.