Analysis Of Postoperative Gastroparesis Associated With The Anastomotic Fashion Of Jejunojejunal Anastomosis In Roux-en-y Reconstruction:A Retrospective Study

Background: Postoperative gastroparesis(PG)is a common complication and one of the causes for prolonged hospital stay or readmission after abdominal surgeries.Roux-en-Y reconstruction method has been proven to be beneficial over Billroth reconstruction methods in abdominal surgeries,however it commonly presents with postoperative gastroparesis as complication,while its pathogenesis remains poorly understood up to date.Roux-en-Y reconstruction surgeries comprise of a minimum of two anastomoses,one proximal(gastrojejunostomy,choledochojejunostomy or pancreaticojejunostomy)and one distal(jejunojejunostomy).The distal anastomosis can be either a side to side anastomosis or end to side anastomosis.Up till now,the relationship between the anastomotic fashion of jejunojejunal anastomosis and postoperative gastroparesis has not been established.Objective: The aim of this study was to explore the association of postoperative gastroparesis with the anastomotic fashion of jejunojejunal anastomosis in Roux-en-Y reconstruction surgeries.Methods: A retrospective study was conducted for patients who underwent abdominal surgeries,either gastric preserved or proximal gastric preserved surgeries,followed by Roux-en-Y reconstruction from July 2013 to October 2017 at Zhongda Hospital.The medical records of patients undergoing abdominal surgeries followed by Roux-en-Y reconstruction were obtained and after exclusion of patients not qualifying for our criteria,a total of 180 patients were analyzed and compared to find the association between the anastomotic fashion and the occurrence of postoperative gastroparesis.Results: Postoperative gastroparesis occurred in 23%(n = 41)of the patients.There was a significant difference between side to side and end to side jejunojejunal anastomosis regarding the frequency of postoperative gastroparesis(28%(33/118)vs 13%(8/62),P = 0.022).We have observed a higher occurrence of postoperative gastroparesis with a side to side jejunojejunal anastomosis using circular staplers.The use of circular staplers coincides with the side to side anastomotic fashion thus,the relevance to occurrence of PG.Conclusions: Our results revealed that the occurrence of postoperative gastroparesis has an obvious association with the anastomotic fashion of jejunojejunal anastomosis in Roux-en-Y reconstruction surgeries.Patients undergoing abdominal surgeries followed by a Roux-en-Y reconstruction with a side to side jejunojejunal anastomosis using circular staplers are more prone to suffer from postoperative gastroparesis.