Subjective and functional results after total gastrectomy: prospective study for longterm comparison of reconstruction procedures.
BACKGROUND
many reconstruction procedures have been developed in efforts to resolve patients' complaints after total gastrectomy. however, there have been few reports of longterm comparisons between reconstruction procedures, especially with regard to the prevention of duodenal food passage. this study was undertaken to compare the longterm subjective and functional results among roux-en-y esophagojejunostomy (r-y), r-y with pouch (p-y), and jejunal interposition with pouch (p-i) after total gastrectomy.


METHODS
consecutive patients requiring curative total gastrectomy were enrolled in this prospective study by the envelope method.


RESULTS
hospital stay was longer following a p-i than an r-y or a p-y. over 50% of r-y patients complained of heartburn, and 20% of r-y patients showed dumping syndrome throughout the postoperative period, with this rate being significantly different from rates in the other two groups. p-y patients complained of early satiety in the late postoperative period, while p-i patients complained of early satiety in the early postoperative period. the nutritional index in p-i patients was higher than those in patients with the other two procedures. gastrointestinal and hepatobiliary dual scintigraphy (ghds) showed that the rate of bile reflux with an r-y was relatively high after surgery. food reflux with a p-y was increased (9.4% to 11.1%), but with a p-i food reflux was decreased at 3 years after surgery (13.3% to 9.9%). patients with a p-y had a faster recovery of body, weight in the early postoperative period; however, at 5 years after operation, body weight recovery with a p-i was greatest.


CONCLUSIONS
reconstruction should be performed with pouch formation after total gastrectomy with curative intent.
Adachi
Shinya
S
Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan.
Inagawa
Satoshi
S
Enomoto
Tsuyoshi
T
Shinozaki
Eiji
E
Oda
Tatsuya
T
Kawamoto
Toru
T
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001835:Body Weight; D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011178:Postgastrectomy Syndromes / Q000209:etiology; D011446:Prospective Studies; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013995:Time; D016896:Treatment Outcome