Yonsei Med J.  2014 Jan;55(1):162-169. 10.3349/ymj.2014.55.1.162.

Totally Laparoscopic Roux-en-Y Gastrojejunostomy after Laparoscopic Distal Gastrectomy: Analysis of Initial 50 Consecutive Cases of Single Surgeon in Comparison with Totally Laparoscopic Billroth I Reconstruction

  • 1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ugids@naver.com


Roux-en-Y reconstruction (RY) in laparoscopic distal gastrectomy for gastric cancer is a more complicated procedure than Billroth-I (BI) or Billroth-II. Here, we offer a totally laparoscopic simple RY using linear staplers.
Each 50 consecutive patients with totally laparoscopic distal gastrectomy with RY and BI were enrolled in this study. Technical safety and surgical outcomes of RY were evaluated in comparison with BI.
In all patients, RY gastrectomy using linear staplers was safely performed without any events during surgery. The mean operation time and anastomosis time were 177.0+/-37.6 min and 14.4+/-5.6 min for RY, respectively, which were significantly longer than those for BI (150.4+/-34.0 min and 5.9+/-2.2 min, respectively). There were no differences in amount of blood loss, time to flatus passage, diet start, length of hospital stay, and postoperative inflammatory response between the two groups. Although there was no significant difference in surgical complications between RY and BI (6.0% and 14.0%), the RY group showed no anastomosis site-related complications.
The double stapling method using linear staplers in totally laparoscopic RY reconstruction is a simple and safe procedure.


Intracorporeal Roux-en-Y gastrojejunostomy; totally laparoscopic distal gastrectomy; intracorporeal Billroth-I reconstruction; technical safety; surgical outcome

MeSH Terms

Gastric Bypass/*methods
Middle Aged
Stomach Neoplasms/surgery


  • Fig. 1 Placement of trocars in a laparoscopic distal gastrectomy.

  • Fig. 2 Surgical techniques for gastrojejunostomy. (A) Side-to-side anastomosis between the greater curvature of the stomach and the jejunum with a linear stapler. (B) Closure of the common entry hole using a linear stapler. (C) Completion of the gastrojejunostomy.

  • Fig. 3 Surgical techniques for jejeunojejunostomy. (A) Side-to-side jejunojejunostomy using a linear stapler. (B and C) Closure of the common entry hole using a linear stapler. (D) Completion of the jejunojejunostomy.

  • Fig. 4 Operation time. Changes of operation time by case number accumulation for RY and BI. BI, Billroth-I; RY, Roux-en-Y reconstruction.

  • Fig. 5 Anastomosis time. Changes in anastomosis time by case number accumulation for RY and BI. BI, Billroth-I; RY, Roux-en-Y reconstruction.

  • Fig. 6 Changes of preoperative and postoperative laboratory data. (A) White blood cell count (WBC) (×103/µL), neutrophil (×103/µL), total protein (g/dL), albumin (mg/dL) level. (B) Serum high sensitive C-reactive protein level (mg/L). BI, Billroth-I; RY, Roux-en-Y reconstruction; POD, postoperative day.


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