Anti-reflux pouch-esophagostomy after total gastrectomy.
The most prominent and severe complication after a total gastrectomy is severe reflux esophagitis. We have developed a procedure involving jejunal pouch-esophagostomy to avoid such postoperative reflux. The novel procedure reported here initially involves folding a jejunal segment of approximately 35 cm in length. A side-to-side jejuno-jejunostomy at the anti-mesenteric side was then affected using a 100-mm linear stapler. This resulted in a jejunal pouch, 10 cm in length, and a 7-cm apical section of unstapled jejunal loop. Finally, an esophago-jejuno end-to-side anastomosis (pouch-esophagostomy) was formed at the right anterior wall of the apical bridge using a circular stapler. We have therefore introduced a "partial posterior fundoplication"-like wrapping technique to the standard gastrectomy using the apical bridge of the jejunal pouch. Only a little postoperative reflux was revealed by barium meal testing - even in the Trendelenburg's position - in patients treated with the described anti-reflux anastomosis procedure. Jejunal pouch reconstruction with partial posterior wrapping is a useful procedural addition for minimizing reflux esophagitis following a total gastrectomy.
Kobayashi
Michiya
M
Department of Human Health and Medical Science, Kochi Medical School, Nankoku, Japan.
Okamoto
Ken
K
Okabyashi
Takehiro
T
Akimori
Toyokazu
T
Namikawa
Tsutomu
T
Sakamoto
Junichi
J
Hanazaki
Kazuhiro
K
D000714:Anastomosis, Surgical / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D004942:Esophagitis, Peptic / Q000209:etiology* / Q000601:surgery*; D004946:Esophagostomy / Q000295:instrumentation* / Q000379:methods*; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D019738:Surgically-Created Structures; D016896:Treatment Outcome