[Effect of reconstruction method on nutritional status after gastrectomy. Comparison of Roux-Y esophagojejunostomy and jejunum interposition].
Body composition, postprandial symptoms and social performance were studied in 61 tumor-free patients after total gastrectomy and Roux-Y esophagojejunostomy (n = 30) or jejunal interposition (n = 31). Emptying of the gastric substitute and small bowel transit of a 99mTc-labeled solid test meal were measured by scintigraphy. Serum glucose levels, and immunoreactive insulin were measured simultaneously. The lowest postoperative weight was 73 +/- 2% of the pre-morbid weight in Roux-Y cases, and 77 +/- 2% after jejunal interposition, the weight at study was 82 +/- 2% respectively 87 +/- 1% of the premorbid weight (p less than 0.05). Of the patients younger than 60 years at operation only one third of the twelve Roux-Y cases had resumed their work, as compared to two thirds of the eighteen interposition cases (p = 0.056). The incidences of the postprandial symptoms were not different among the modes of reconstruction, except for a slightly higher incidence of late dumping in Roux-Y (17% vs. 10%). After correction for gender higher mean values of fat-free mass, total body water, and intracellular water were measured in interposition cases (bioelectric impedance analysis). The emptying half-time of the gastric substitute was 488 s in the Roux-Y group, and 378 s after interposition (p = 0.05), whereas the small bowel transit (median: 200 min) showed no differences between the groups. There was no correlation between t1/2 or small bowel transit and the nutritional data. Early dumping (p = 0.01) was the only symptom significantly associated with rapid emptying of the gastric substitute.(ABSTRACT TRUNCATED AT 250 WORDS)
Miholic
J
J
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover.
Meyer
H J
HJ
Balks
J
J
Kotzerke
J
J
D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D007328:Insulin / Q000097:blood; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D011178:Postgastrectomy Syndromes / Q000175:diagnosis; D011183:Postoperative Complications / Q000175:diagnosis*; D013274:Stomach Neoplasms / Q000601:surgery*
D001786:Blood Glucose; D007328:Insulin
Einfluss der Rekonstruktionsmethode auf den Ernährungszustand nach Gastrektomie. Vergleich von Roux-Y-Oesophagojejunostomie und Jejunuminterposition.