Objective To evaluate the safety and effect of seromuscular layer anastomosis in small intestinal suture. Methods Forty patients with hepatobiliary and pancreatic diseases undergoing biliojejunostomy or cystojejunostomy were randomly divided into seromuscular layer anastomosis group (n=20) and two-layer anastomosis group (n=20) before operation， which received Roux-en-Y end-to-side jejunal seromuscular layer anastomosis and two-layer anastomosis, respectively. Intestinal anastomotic complications and other indexes such as anus venting time were recorded in each group. Results Neither group had intestinal anastomotic complications such as leakage, stricture, obstruction and hemorrhage. Time of venting to normal were (3.6±0.9) d and (3.6±0.8) d in seromuscular layer and two-layer anastomosis group respectively, there was no significant difference between them (Pgt;0.05). Conclusion Seromuscular layer anastomosis is a safe and effective method of small intestinal anastomsis.
Objective To systematically review perioperative safety and middle-term and long-term complications of Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis after distal subtotal gastrectomy by a meta-analysis. Methods Literatures about Roux-en-Y and Billroth-Ⅰ anastomoses after distal subtotal gastrectomy in Embase, PubMed, MedLine, and the Cochrane Library databases were searched. Retrieval time was from December 1, 2015 to March 1, 2016. According to the inclusion and exclusion criteria, two reviewers independently screened literatures, extracted data, and evaluated the qualities of the included studies. Then meta-analysis was performed using Review Manager Version 5.1 software. Results Five randomized controlled trials (RCTs) were finally included involving 600 patients, of which 302 patients were underwent Roux-en-Y anasomosis, 298 patients were underwent Billroth-Ⅰ anasomosis. The results of meta-analysis showed that the Billroth-Ⅰ anastomosis operation had more advantages in the operative time 〔WMD: 38.95; 95%CI: (19.86, 58.04);P<0.000 1〕 and the intraoperative bleeding 〔WMD: 34.85; 95%CI: (2.13, 67.56);P=0.04〕. However, the Roux-en-Y anastomosis had more significant effects in the prevention of bile reflux 〔OR: 0.03; 95%CI: (0.01, 0.11);P<0.000 01〕 and the residual gastritis 〔OR: 0.37; 95%CI: (0.25, 0.54);P<0.000 01〕. There were no differences in the hospital stay 〔WMD: 2.96; 95%CI: (–0.00, 5.93);P=0.05〕, anastomotic leakage 〔OR: 0.43; 95%CI: (0.11, 1.68);P=0.23〕, anastomotic stricture 〔OR: 1.84; 95%CI: (0.61, 5.53);P=0.27〕, reflux esophagitis〔OR: 0.63; 95%CI: (0.28, 1.44);P=0.27〕, and delayed gastric emptying 〔OR: 1.24; 95%CI: (0.46, 3.30);P=0.67〕 between the Roux-en-Y anastomosis and Billroth-Ⅰ anastomosis. Conclusions Billroth- I anastomosis and Roux-en-Y anastomosis have their own advantages and disadvantages, in term of safety of Billroth- I anastomosis is better, but it’s quality of life is worse as compared with Roux-en-Y anastomosis. However, more high-quality, well-designed, adequate RCTs data are needed to validate.
Objective To compare the effectiveness between a new hand-sewn intestinal anastomosis and stapled anastomosis during Roux-en-Y anastomosis of gastric cancer. Methods Retrospectively, we collected 200 gastric cancer patients who underwent radical distal or total gastrectomy from January 2014 to June 2017 in our hospital, and divided them into observation group (new hand-sewn anastomosis, n=100) and control group (stapled anastomosis, n=100) according to the type of anastomosis. The time and cost taken to perform the anastomosis, the incidence of postoperative complications (including anastomotic leakage, bleeding, and stenosis), and hospital stay were compared. Results The cost of anastomosis in the observation group was significantly lower than that of the control group [(194.1±13.5) RMB vs (5 270.3±852.7) RMB, P<0.001], and the time taken to perform was just slightly longer in the observation group [(8.34 ± 0.65) minvs (8.29±0.61 ) min, P=0.540], additionally the incidences between the observation group and the control group, in regards to anastomotic bleeding [0 (0/100) vs 3% (3/100), P=0.246], leakage [0 (0/100) vs 1% (1/100), P=1.000], stenosis [0 (0/100) vs 2% (2/100), P=0.497], and hospital stay [(18.8±7.4) d vs (19.2±6.2) d, P=0.175], showed no significant difference between the 2 groups. Conclusion The new hand-sewn anastomosis technology is safe and effective, easy to learn, and it can save money and time, which is worth promoting.