[Jejunal pouch and interposition reconstruction after a total gastrectomy for cancer].
The authors modified the operative procedures used in pouch and interposition (PI) reconstruction in an attempt to improve the surgical results after a total gastrectomy, because a randomized controlled trial had revealed that the clinical assessment of PI was quite poor, even though it is a physiological route. In most of the treated patients, the gastric emptying test revealed delayed emptying, and an X-ray video film showed folding and twisting of the jejunal conduit between the pouch and duodenum, which disturbed the transmission of the nutrition. Modified PI (m-PI) was performed by decreasing the length of the jejunal conduit and widening the jejunal pedicle to preserve the blood and nerve supply. The m-PI group showed a lower incidence of symptoms, a greater food intake, and a greater weight recovery than the PI group. The gastric emptying test also revealed an acceptable degree of emptying. We conclude that the m-PI reconstruction is more useful for improving the postoperative quality of life than the previously used method of PI reconstruction.
Nakane
Y
Y
2nd Department of Surgery, Kansai Medical University, Moriguchi, Japan.
Akehira
K
K
Sato
M
M
Okumura
S
S
Yamamichi
K
K
Okamura
S
S
Hioki
K
K
D000714:Anastomosis, Surgical / Q000379:methods; D004386:Duodenum / Q000601:surgery; D004947:Esophagus / Q000601:surgery; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008722:Methods; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome