Pouch Roux-en-Yvs No Pouch Roux-en-Y following total gastrectomy:a meta-analysis based on 12 studies

After a total resection of the stomach,the continuity of the gastrointestinal tract can be restored either by Rouxen-Y esophagojejunostomy with or without a pouch.There is still no consensus on the best reconstruction technique.The aim of this report was to derive a more precise estimation of Roux-en-Y esophagojejunostomy with a pouch compared with Roux-en-Y esophagojejunostomy without a pouch.Studies were identified by PubMed and Embase searches,and the inclusion criteria were randomized controlled trials (RCTs) comparing reconstruction techniques between Roux-en-Y with and without a pouch.A total of 12 studies including 1,018 patients were included.The meta-analysis shows that pouch Roux-en-Y does not significantly increase total postoperative complications,anastomotic leakage or mortality.Importantly,there is no significant difference in 5-year survival rates between the two groups.Patients with Roux-en-Y esophagojejunostomy complained significantly less of reflux symptoms and dumping syndrome,and had significantly less severe reflux esophagitis.Quality of life was significantly improved in patients with Roux-en-Y esophagojejunostomy with a pouch compared with patients who received Roux-en-Y reconstruction without a pouch.The results indicate the need for Roux-en-Y esophagojejunostomy with a pouch is a gastric substitute after total gastrectomy by comparison with Roux-en-Y esophagojejunostomy without a pouch.