Fixation of Roux Limb and Duodenal Stump Effects the Prevention of Peterson’s Internal Hernia and Roux Stasis Syndrome After Laparoscopic Distal Gastrectomy

Background Roux-en-Y (R-Y) reconstruction is a standard option for reconstruction after laparoscopic distal gastrectomy (LDG). Though this technique takes more time than Billroth I (B-I) reconstruction, leakage is rare, and it is useful for management of a small remnant stomach. Complications occur and include Petersen’s hernia and Roux stasis syndrome. Petersen’s hernia is a rare complication that results in significant morbidity and poor quality of life.Here we report a case series of a simple and effective method for preventing Petersen’s hernia and Roux stasis syndrome.Methods We performed ante-colic R-Y reconstruction after LDG. After R-Y reconstruction, we fixed the alimentary limb onto the duodenal stump in a proper radian. Via this small improvement in the Roux limb, the alimentary limb was placed to the right of the ligament of Treitz. This not only changed the anatomy of the Petersen’s defect, but it also kept a fluent direction of gastrointestinal anastomosis and avoided a cross-angle after jejunojejunostomy.Results From July 2015 to March 2017, we performed this technique in 31 consecutive patients. The operative time was (308.0 ± 84.6 minutes). Fixation of the alimentary limb onto the duodenal stump took about 10 minutes. Two (6.5%) patients experienced pneumonia and pancreatitis, respectively. No patient required reoperation or readmission. All patients were followed up for at least 2 years, and none of the patients developed postoperative complications related to internal hernia or Roux stasis syndrome.Conclusions This 10 minute technique is a very effective method to reduce the onset of Petersen’s hernia and Roux stasis syndrome in patients who undergo LDG.