Comparative Analysis Of Uncut Roux-en-Y And ? Shaped Anastomoses In Totally Laparoscopic Total Gastrectomy

Objective:To investigate the safety and feasibility of totally laparoscopic total gastrectomy,and to compare the perioperative and postoperative data of total laparoscopic gastrectomy between Uncut Roux-en-Y anastomosis and ? shaped anastomosis.Methods:The clinical data of 75 patients with gastric cancer who underwent totally laparoscopic total gastrectomy in the Second Affiliated Hospital of Dalian Medical University from January 2016 to June 2019 were retrospectively analyzed.They were divided into Uncut RY group(39 cases,52%)and ? shaped anastomosis group(36 cases,48%)in terms of reconstruction method.The perioperative and postoperative data of the two groups of patients were compared.SPSS 24.0 statistical software was used to analyze the data.The chi-square test or Fisher exact test was used for categorical data.The measurement data were analyzed by t test or rank sum test.A p-value less than 0.05(typically<0.05)is statistically significant.Results: Totally laparoscopic total gastrectomy was successfully performed in both groups,without conversion to open surgery,no secondary surgery,and no perioperative death.There were no statistically significant differences between the two groups with respect to general patient information such as age and gender between the two groups(P>0.05).The operation time of patients in the Uncut RY group and the ?-shaped anastomosis group were(215.10 ± 35.71)min and(191.58 ± 36.43)min,respectively.The first postoperative meal of patients in the Uncut RY group and the ?-shaped anastomosis group were 3(2 ?4)d and 4(3?6)d,respectively.The differences between the two groups with respect to operation time and first postoperative meal were statistically significant(P <0.05).Intraoperative blood loss,postoperative hospital stay,and hospitalization costs were not statistically significant between the two groups of patients(P>0.05).There were 2 cases of Roux retention syndromes in the Uncut RY group and 8 cases in the ?-shaped anastomosis group.The differences were statistically significant(P<0.05).There was no significant difference in the incidence of postoperative complications such as anastomotic leakage,pneumonia or pleural effusion,abdominal bleeding,incision infection,reflux esophagitis,dumping syndrome,and anastomotic ulcers(P > 0.05).Conclusion:Totally laparoscopic total gastrectomy is safe and feasible.The operation time was shorter in ?-shaped anastomosis compared to that of Uncut Roux-en-Y anastomosis,while patients in the Uncut Roux-en-Y anastomosis group had earlier postoperative feeding,and the incidence of Roux retention syndrome is lower in the group of Uncut Roux-en-Y anastomosis.