title: Optimal gastric pouch reconstruction post-gastrectomy.
abstract: BACKGROUND
  Gastric pouches have the potential to improve nutrition following total gastrectomy, compared with standard reconstruction. However, a consensus view of clinical benefit is not available, at least partly due to a lack of standardization of pouch design or size. This study was undertaken to identify optimal conditions for pouch design.
  
  
  METHODS
  A mathematical model was established and a porcine model constructed to evaluate the pressure/volume dynamics of the pouch. A "J" pouch was constructed at anastomotic lengths of 5, 10, 15, and 20 cm. Each pouch was distended with saline and the pressure/volume relationship established.
  
  
  RESULTS
  Mathematically, increasing the anastomotic length of the pouch to 15 cm increases the volume significantly; thereafter, there is minimal benefit of increasing the pouch length further. For smaller pouches (5 and 10 cm) a 350-to 400-ml volume (approximate meal volume in the elderly) is never achieved until higher pressures (45 cmH(2)O) are applied. However, in the larger pouches (15 and 20 cm) a 350-to 400-ml volume is readily achieved at basal pressures of 15 cmH(2)O.
  
  
  CONCLUSIONS
  Smaller pouches never achieve adequate volumes at basal pressures; accordingly, it is unlikely that they will lead to any clinical benefit. Further in-vivo studies should therefore be based upon 15-cm pouch designs.
authors: Department of Upper Gastrointestinal Surgery, Aberdeen Royal Infirmary, Grampian University Hospital Trust, Aberdeen, UK.
authors: Shayanthan
authors: S
authors: Nanthakumaran
authors: Stuart A
authors: SA
authors: Suttie
authors: Howard W
authors: HW
authors: Chandler
authors: Kenneth G M
authors: KG
authors: Park
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D005743:Gastrectomy / Q000379:methods*; D015391:Gastroplasty / Q000379:methods*; D066298:In Vitro Techniques; D008962:Models, Theoretical; D011182:Postoperative Care; D013274:Stomach Neoplasms / Q000601:surgery*; D013552:Swine