Optimal gastric pouch reconstruction post-gastrectomy.
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.
Nanthakumaran
Shayanthan
S
Department of Upper Gastrointestinal Surgery, Aberdeen Royal Infirmary, Grampian University Hospital Trust, Aberdeen, UK.
Suttie
Stuart A
SA
Chandler
Howard W
HW
Park
Kenneth G M
KG
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