Roux-en-Y reconstruction alleviates radical gastrectomy-induced colitis via down-regulation of the butyrate/NLRP3 signaling pathway.

BACKGROUND: Different methods for digestive tract reconstruction have a complex impact on the nutritional status of gastric cancer (GC) patients after radical gastrectomy. Previous studies reported that Roux-en-Y (R-Y) reconstruction resulted in obvious weight reduction and improvement in type 2 diabetes in obese patients. We investigated the relationship between R-Y reconstruction, gut microbiota, and the NLRP3 inflammasome in GC patients with poor basic nutrition. METHODS: Changes in the gut microbiota after radical gastrectomy accomplished by different methods of digestive tract reconstruction were investigated via fecal microbiota transplantation. The underlying mechanisms were also explored by analyzing the role of the microbiota, butyrate, and the NLRP3 inflammasome in the colon tissues of colitis model mice and GC patients after radical gastrectomy. FINDINGS: R-Y reconstruction effectively relieved intestinal inflammation and facilitated nutrient absorption. 16S rRNA analysis revealed that gavage transplantation with the fecal microbiota of R-Y reconstruction patients could reverse dysbacteriosis triggered by radical gastrectomy and elevate the relative abundance of some short-chain fatty acid (SCFA)-producing bacteria. Subsequently, butyrate negatively regulated the NLRP3-mediated inflammatory signaling pathway to inhibit the activation of macrophages and the secretion of pro-inflammatory mediators such as caspase-1 and interleukin (IL)-1ß, decreasing the level of intestinal inflammation and promoting nutrient absorption. INTERPRETATION: R-Y reconstruction induced colonization with SCFA-producing bacteria to alleviate radical gastrectomy-induced colitis by down-regulating the NLRP3 signaling pathway. This can be a new strategy and theoretical basis for the management of the postoperative nutritional status of GC patients. FUNDING: This work was supported by the National Nature Science Foundation of China (81974375), the BoXi cultivation program (BXQN202130), and the Project of Youth Foundation in Science and Education of the Department of Public Health of Suzhou (KJXW2018001).

Advanced Roux-en-Y hepaticojejunostomy with magnetic compressive anastomats in obstructive jaundice dog models.

BACKGROUND: Although commonly used procedure, Roux-en-Y hepaticojejunostomy (RYHJ) remains to be complicated, time consuming, and has a relatively poor prognosis. We designed the magnetic compressive anastomats (MCAs) to perform RYHJ more efficiently and safely. MATERIALS AND METHODS: 36 dogs were divided into two groups randomly. After obstructive jaundice model construction, RYHJ was performed with MCAs in study group or by hand-sewn in control group. Both groups were followed for 1, 3, and 6 months after RYHJ. The liver function and postoperative complications were recorded throughout the follow-up. At the end of each time point, dogs were sent for magnetic resonance imaging (MRI) and sacrificed. Anastomotic samples were taken for anastomotic narrowing rate calculation, histological analyses, tensile strength testing, and hydroxyproline content testing. RESULTS: The anastomotic construction times were 44.20 ± 23.02 min in study group, compared of 60.53 ± 11.89 min in control group (p < 0.05). The liver function recovered gradually after RYHJ in both groups (p > 0.05). All anastomats were expelled out of the body in 8.81 ± 2.01 days. The gross incidence of morbidity and mortality was 33.3% (6/18) and 16.7% (3/18) in study group compared with 38.9% (7/18) and 22.2% (4/18) in control group (p > 0.05), and there is no single case of anastomotic-specific complications happened in study group. The narrowing rates of anastomosis were 14.6, 18.5, and 18.7% in study group compared with 35.4, 36.9, and 34% in control group at 1st, 3rd, and 6th month after RYHJ (p < 0.05). In study group, preciser alignment of tissue layers and milder inflammatory reaction contributed to the fast and better wound healing process. CONCLUSION: Perform RYHJ with MCAs is safer, more efficient than by hand-sewn method in obstructive jaundice dog models.

Evaluation of a biofragmentable anastomosis ring for small intestinal anastomosis in ponies.

Six ponies divided into two groups of three were used in a double crossover study design. Group 1 ponies had a small intestinal resection and anastomosis performed using a biofragmentable anastomosis ring (BAR); group 2 ponies had a hand-sewn small intestinal resection and anastomosis using a Gambee suture pattern. Approximately 30 days later, all ponies had a second celiotomy and anastomosed segments were removed. Group 1 ponies had a hand-sewn anastomosis performed and group 2 had a BAR. The anastomotic sites were collected at necropsy approximately 30 days later. Anastomosed intestinal segments were evaluated with ultrasound to determine lumen diameter, area, circumference, and wall thickness. Gross descriptions of adhesions were recorded and sections of the anastomotic site were taken for histological evaluation. Time to perform the BAR anastomosis was significantly less (P = .0004) than for the hand-sewn Gambee anastomosis. Ponies with handsewn anastomoses had no signs of colic, whereas five of six ponies with BAR anastomoses had several episodes of abdominal discomfort, between day 16 to 18, corresponding to the time of BAR disintegration as determined by abdominal radiographs. Hand-sewn anastomoses had a tendency to have more adhesion formation than BAR anastomoses, but all anastomoses, except one BAR anastomosis, were graded as having a low obstructive potential. BAR anastomoses had a significantly larger mean index of stenosis for intraluminal diameter (76% +/- 13.6), area (93.7% +/- 6.01) and circumference (75.8% +/- 14.0) than the hand-sewn anastomoses (26.6% +/- 11.9; 44.6% +/- 19.5; 26.8% +/- 12.7). The BAR anastomoses also had a significantly smaller mean intraluminal diameter (0.96 cm +/- 0.49), area (0.838 cm2 +/- 0.65) and circumference (3.28 cm +/- 1.63) than the hand sewn anastomoses (3.11 cm +/- 0.73; 7.99 cm2 +/- 3.9; 10.3 cm +/- 2.47). In addition, the BAR anastomoses had a significantly larger (P = .0069) bowel wall thickness at the anastomoses and a significantly larger (P = .047) wall thickness proximal to the anastomosis than the hand-sewn anastomoses, indicating some degree of hypertrophy because of chronic obstruction. No significant difference was found in the diameter, area, or circumference between bowel proximal and distal to the anastomosis for either the BAR or Gambee techniques, or between the BAR and Gambee anastomosis as a measure of chronic obstruction. There was a significantly higher (P = .0043) histological score (worse healing) for mucosal healing and continuity for the BAR, as well as a tendency to score higher for inflammation, anastomotic alignment, and anastomotic fibrosis. The BAR technique had a significantly higher (P = .0043) total histological score than the Gambee technique. Although the BAR was advantageous in many respects, results of this study suggest that it should not be used for equine small intestinal anastomosis because of the potential for stricture formation.

Use of a modified Roux-en-Y procedure for treatment of pyloroduodenal obstruction in a horse.

A modification of the Roux-en-Y anastomosis procedure was used to bypass a pyloroduodenal mass in a 12-year-old Arabian stallion. Clinical signs had consisted of a 4-week progression of ventral and hind limb edema, hypoproteinemia, fecal occult blood, intermittent abdominal pain, weight loss, and gastric reflux. On exploratory celiotomy, an obstructive mass was found in the pylorus and proximal portion of the duodenum. Gastrojejunostomy and duodenojejunostomy were performed by use of stapled side-to-side anastomosis techniques. Inaccessibility of the obstructed pyloric region prevented resection of the affected area.