Brief Article
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World J Gastroenterol. Jan 21, 2012; 18(3): 251-256
Published online Jan 21, 2012. doi: 10.3748/wjg.v18.i3.251
Roux-en-Y reconstruction does not require gastric decompression after radical distal gastrectomy
Cheng-Jueng Chen, Tsang-Pai Liu, Jyh-Cherng Yu, Sheng-Der Hsua, Tsai-Yuan Hsieh, Heng-Cheng Chu, Chung-Bao Hsieh, Teng-Wei Chen, De-Chuan Chan
Cheng-Jueng Chen, Jyh-Cherng Yu, Sheng-Der Hsua, Chung-Bao Hsieh, Teng-Wei Chen, De-Chuan Chan, Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, 11490 Taipei, Taiwan, China
Tsang-Pai Liu, Department of Surgery, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Peitou, 10449 Taipei, Taiwan, China
Tsai-Yuan Hsieh, Heng-Cheng Chu, Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, 11490 Taipei, Taiwan, China
Author contributions: Chen CJ and Liu TP contributed equally to this work; Chen CJ, Liu TP, Yu JC, and Chan DC designed the research; Chen CJ, Hsua SD, Hsieh TY, and Chu HC performed the research; Hsieh CB and Chen TW performed the measurements and analyses; Chen CJ and Chan DC wrote the paper; all the authors participated in the critical review and in the final approval of the manuscript.
Correspondence to: De-Chuan Chan, MD, Associate Professor, Chief, Division of General Surgery, Tri-Service General Hospital, No. 325, Sec. 2, Cheng-Kung Rd., Neihu, 11490 Taipei, Taiwan, China. chrischan1168@yahoo.com.tw
Telephone: +886-2-87927191 Fax: +886-2-87927372
Received: June 13, 2011
Revised: September 2, 2011
Accepted: October 28, 2011
Published online: January 21, 2012
Abstract

AIM: To determine whether routine nasogastric (NG) decompression benefitted patients undergoing radical gastric surgery.

METHODS: Between January 1998 and December 2008, 519 patients who underwent distal gastrectomy for gastric cancer were retrospectively divided into 2 time-period cohorts; those treated with Billroth II (BII) reconstruction in the first 6 years and those with Roux-en-Y (RY) reconstruction in the last 5 years. In the latter group, the patients were further divided into 2 subgroups; with and without nasogastric decompression.

RESULTS: Postoperatively, there were no significant differences in the number of anastomotic leaks between the 3 groups. In the tubeless RY group, time to semi-liquid diet was significantly shorter than in the other 2 groups (4.4 d ± 1.4 d vs 7.2 d ± 1.3 d and 5.9 d ± 1.2 d, P = 0.005). The length of postoperative stay was significantly increased in patients with BII reconstruction compared with patients with RY reconstruction with/without NG decompression (15.4 d ± 4.3 d in BIIgroup vs 12.6 d ± 3.1 d in decompressed RY and 11.4 d ± 3.4 d in the tubeless RY group, P = 0.035). The postoperative pneumonia rate was lowest in the tubeless group and highest in the BII group (1.4% vs 4.6%, P = 0.01). Severe sore throat was noted in 59 (20.7%) members of the BII group, 18 (17.4%) members of the decompressed RY group and 6 (4.2%) members of the tubeless RY group. Fewer patients in the tubeless group complained of severe sore throat (P = 0.001).

CONCLUSION: This study provides support for abandoning routine NG decompression in patients undergoing subtotal gastrectomy with Roux-en-Y gastrojejunostomy.

Keywords: Nasogastric decompression, Billroth II gastrojejunostomy, Roux-en-Y gastrojejunostomy, Radical distal gastrectomy, Gastric cancer