CHỌN LỰA PHƯƠNG PHÁP PHỤC HỒI LƯU THÔNG RUỘT SAU PHẪU THUẬT NỘI SOI CẮT PHẦN XA DẠ DÀY: NHẬN ĐỊNH VỀ MẶT CHỨC NĂNG

Abstract

Introduction: Reconstruction after laparoscopic distal gastrectomy (LDG) was still controversial. In our center, LDG has been applied frequently since 2013. This retrospective study was conducted to evaluate the effectiveness of the 5 types of reconstruction after distal gastrectomy in terms of functional outcomes. Patients and methods: We retrospectively studied 426 patients with gastric adenocarcinoma, who underwent LDG from 2017 to 2020 in our center, followed by 5 types of reconstruction: Billroth 1 (B-I), Billroth 2 delta shape (BII-ds), Billroth 2 with Braun anastomosis (B-II Braun), Billroth 2 with hinged afferent loop (B-II-h) and Roux-en-Y (R-Y). Short-term outcomes included operative characteristics and complications. Long-term outcomes included 1-year endoscopic findings according to the LA and the RGB classification. Results: B-II Braun or R-Y had a longer operating time than other methods (p < 0.001). There was no difference in blood loss, postoperative hospital stay, conversion rate to open surgery, rate and severity of complications. R-Y reconstruction was ideal in maintaining serum albumin (p < 0.001), however, there was no difference in terms of weight and hemoglobin maintenance. Endoscopic results after 1 year did not differ in the rates of reflux esophagitis and gastric remnant gastritis between reconstructions. B-I reconstruction had a high rate of food residue (grade 1-2: 11.7%, grade 3: 5.9%, grade 4: 2.9%). R-Y reconstruction had the lowest rate of bile reflux (4.8%), followed by B-II Braun (14.2%) and B-I, B-II-h, B-II-ds. Conclusion: Roux-en-Y reconstruction had a longer operating time but provided favorable nutritional results and reduced the incidence of bile reflux. B-I reconstruction resulted in a high rate of food residue. B-II with hinge afferent loop was simple in technique and provided favorable functional and nutritional outcomes.