title: Jejunal pouch to avoid stricture after esophagojejunostomy with circular stapler.
abstract: BACKGROUND
  Anastomotic stricture is one of the most common problems in esophagojejunostomy using the end-to-end anastomosing (EEA) instrument (Auto Suture Co, Norwalk, CT) after total gastrectomy. To alleviate the stricture, several methods, such as incision to the scar, balloon dilatation, and steroid injection are available. To avoid stricture, the jejunal pouch may allow use of a larger EEA than Roux-en-Y (ReY) reconstruction does.
  
  
  METHODS
  A total of 45 patients underwent curative total gastrectomy and esophagojejunostomy with jejunal pouch construction (27 patients) or ReY (18 patients), using the EEA. The effects of jejunal pouch construction with a large EEA on avoidance of stricture and benefit to nutritional status were investigated by comparing it with the ReY in terms of postoperative morbidity, postprandial symptoms, and nutritional parameters (serum protein, serum albumin, body weight).
  
  
  RESULTS
  EEA28 or larger could be used in 25 patients in the pouch group and 8 patients in the ReY group (p < 0.05). Stricture developed in one patient in the pouch group and in four patients in the ReY group (p < 0.05). Postprandial symptoms were experienced less frequently (p < 0.05) in the pouch group than in the ReY group. When stricture and symptoms were analyzed according to the size of EEA, they occurred more frequently (p < 0.05) in the patients with EEA25 than those with EEA28 or EEA31. No significant differences were evident in nutritional parameters.
  
  
  CONCLUSIONS
  The choice of jejunal pouch technique allowed the use of a larger EEA than that of ReY reconstruction, resulting in avoidance of anastomotic stricture and postprandial symptoms, though little benefit in nutritional status was evident to the patients after total gastrectomy.
authors.affiliation: Department of Surgery, Maizuru Municipal Hospital, Kyoto, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Tokunaga
authors.forename: J
authors.initials: J
authors.lastname: Ryo
authors.forename: A
authors.initials: A
authors.lastname: Kitaoka
authors.forename: T
authors.initials: T
authors.lastname: Yagi
authors.forename: A
authors.initials: A
authors.lastname: Tokuka
authors.forename: K
authors.initials: K
authors.lastname: Ohsumi
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000295:instrumentation / Q000379:methods*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004946:Esophagostomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007582:Jejunostomy / Q000295:instrumentation / Q000379:methods*; D008197:Lymph Node Excision; D008223:Lymphoma / Q000601:surgery; D008297:Male; D009752:Nutritional Status; D011183:Postoperative Complications / Q000517:prevention & control; D019518:Postprandial Period; D013274:Stomach Neoplasms / Q000601:surgery; D013528:Surgical Staplers; D016896:Treatment Outcome