title: Postoperative evaluation of the jejunal pouch reconstruction following proximal and distal gastrectomy for cancer.
abstract: OBJECTIVE
  To evaluate the efficacy of the jejunal pouch reconstruction following subtotal proximal and distal gastrectomy, a retrospective study examining the postoperative condition of patients who underwent different methods of reconstruction after gastrectomy for cancer was undertaken.
  
  
  METHODS
  Various parameters indicative of postoperative function were evaluated at one year postoperatively, and two major groups were examined. The "proximal gastrectomy" group was composed of patients who underwent either 1) proximal gastrectomy with an interposed jejunal pouch (PG-pouch), 2) proximal gastrectomy with simple jejunal interposition (PG-inter), or 3) total gastrectomy with simple jejunal interposition (TG). The "distal gastrectomy" group was composed of patients who underwent either 4) distal gastrectomy with an interposed jejunal pouch (DG-pouch), 5) distal gastrectomy with simple jejunal interposition (DG-inter), or 6) distal gastrectomy with Billroth 1 reconstruction (B-1).
  
  
  RESULTS
  Volume of meal intake was better preserved and the incidence of abdominal symptoms were less frequent in the PG-pouch and DG-pouch groups. In the PG-inter, DG-inter and DG-pouch groups, none of the patients experienced heartburn or had endoscopic findings consistent with reflux esophagitis, while 2 patients (20.0%) in the PG-pouch group complained of heartburn with evidence of reflux esophagitis on endoscopy. Increase in blood acetaminophen level was milder in both the PG-pouch and DG-pouch groups, signifying improved gastric emptying.
  
  
  CONCLUSIONS
  The jejunal pouch interposition following proximal and distal gastrectomy seems to confer clinical benefit in terms of postoperative function, especially in the form of meal intake, abdominal symptoms, and gastric emptying. The side effect of an improved reservoir may be the incidence of reflux esophagitis seen in 2 patients in the PG-pouch group.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan. sur035@poh.osaka-med.ac.jp
authors.forename: Eiji
authors.initials: E
authors.lastname: Nomura
authors.forename: Hisashi
authors.initials: H
authors.lastname: Shinohara
authors.forename: Hideaki
authors.initials: H
authors.lastname: Mabuchi
authors.forename: Lee
authors.initials: L
authors.lastname: Sang-Woong
authors.forename: Toyooki
authors.initials: T
authors.lastname: Sonoda
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Tanigawa
mesh_terms: D000368:Aged; D001835:Body Weight; D004435:Eating; D004942:Esophagitis, Peptic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005746:Gastric Emptying; D005756:Gastritis / Q000209:etiology; D005763:Gastroenterostomy / Q000379:methods; D006356:Heartburn / Q000209:etiology; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D019738:Surgically-Created Structures