[Comparative study on three types of digestive reconstruction after total gastrectomy].
OBJECTIVE
To investigate the rational digestive reconstruction after total gastrectomy for gastric malignancy.


METHODS
Three types of digestive reconstruction were performed after total gastrectomy in 189 cases with gastric carcinoma. The operating time, morbidity and mortality, food intake, digestive tract symptoms, nutritional status at 1 and 3 years after surgery and 1-, 3-, 5-year cumulative survival were compared.


RESULTS
There were no significant differences among the three procedures in operative morbidity and mortality, postoperative food intake, nutritional status (Hemoglobin, total protein and labium), and incidences of diarrhea and dumping syndrome (P > 0.05). The overall 1-, 3-, 5-year survival rates were 75.3%, 38.2% and 20.5% respectively, and there were no significant differences among the three groups (P > 0.05). Orr-type and P-type esophagojejunostomy had an advantage of anti-esophageal reflux, and were obviously superior to Moynihan-type anastomosis (P< 0.01). Compared with P-type reconstruction, Orr-type reconstruction was simpler with shorter operating time, and less complications.


CONCLUSIONS
Orr-type Roux-en-Y esophagojejunostomy can be recommended as an adaptable method of digestive reconstruction after total gastrectomy for gastric cancer because of its avoiding reflux esophagitis, maintaining better nutritional status and quality of life, and simpler procedure.
Wei
Hong-bo
HB
Department of Gastrointestinal Surgery, The Thir d Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China. drwhb@21cn.com
Wei
Bo
B
Zheng
Zong-heng
ZH
Zheng
Feng
F
Qiu
Wan-shou
WS
Guo
Wei-ping
WP
Chen
Tu-feng
TF
Wang
Tian-bao
TB
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D004947:Esophagus / Q000601:surgery; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods*; D013274:Stomach Neoplasms / Q000601:surgery*