Factors influencing the development of small intestinal obstruction following total gastrectomy for gastric cancer: The impact of reconstructive route in the Roux-en-Y procedure

Background/Aims: The factors influencing the development of small intestina l obstruction following gastric surgery are controversial. Methodology: Univariate and multivariate analyses were carried out on data from 48 patients with gastric cancer who underwent total gastrectomy and Ro ux-en-Y reconstruction for a potential cure. Results: Of these 48 patients, 11 (22.9%) presented with mechanical obstruc tion in the small intestine postoperatively. There were no statistically si gnificant differences with regard to age, sex, and the presenting pathology . The development of obstruction was not related to a longer operation time , a greater estimated blood loss during surgery, an extensive lymph node di ssection and a combined resection of adjacent organs. The probability that the antecolic anastomosis would cause obstruction was significant when comp ared with findings in case of the retrocolic anastomosis (P < 0.05). In the multivariate logistic regression analysis, the significant risk factors re lated to the development of small intestinal obstruction proved to be recon structive route of jejunal loop. Conclusions: In potentially curative patients undergoing total gastrectomy, retrocolic anastomosis should be attempted to prevent the development of p ostoperative intestinal obstruction.