title: [Comparative study on four different reconstruction procedures after total gastrectomy].
abstract: OBJECTIVE
  To investigate the optimal reconstruction technique after total gastrectomy.
  
  
  METHODS
  A total of 159 patients with gastric cancer undergoing total gastrectomy in Tianjin Cancer Hospital between January 2005 and December 2007 were divided into 4 groups according to the reconstruction technique: group A(functional jejunal interposition with a pouch, n=46), group B(modified Braun type II(, n=38), group C (P pouch with Roux-en-Y esophagojejunostomy, n=25), group D(Roux-en-Y esophagojejunostomy, n=50). Quality of life(QOL), nutritional status 1 year after surgery, and perioperative complications were analyzed.
  
  
  RESULTS
  There were no significant differences in perioperative complications(P>0.05). One year after operation, QOL(Visick index) was better in group A than that in group B, C and D(P<0.05), and group D was inferior to group A, B and C(P<0.05). The increase in food intake, weight gain, hemoglobin and total protein were better in group A than those in group B, C and D(P<0.05) and group D was inferior to group A, B and C(P<0.05). The prognostic nutrition index ratio of the four groups were 1.21±0.15, 1.14±0.97, 1.15±0.16, and 1.10±0.16, respectively. Group A was better than that in group B, C and D (P<0.05) and group D was inferior to group A, B and C(P<0.05). The incidences of dumping syndrome, reflux esophagitis, Roux-en-Y stasis syndrome in group A were 4.3%(2/46), 2.2%(1/46) and 2.2%(1/46), respectively, which were significantly lower than those in other groups (P<0.05).
  
  
  CONCLUSIONS
  Functional jejunal interposition with a pouch is associated with improved nutritional condition and quality of life, and less perioperative complications. It is a reasonable reconstruction method after total gastrectomy.
authors.affiliation: Department of Gastric Cancer, Tianjin Medical University, Tianjin 300060, China. .
authors.forename: Liang-liang
authors.initials: LL
authors.lastname: Wu
authors.forename: Han
authors.initials: H
authors.lastname: Liang
authors.forename: Ru-peng
authors.initials: RP
authors.lastname: Zhang
authors.forename: Yuan
authors.initials: Y
authors.lastname: Pan
authors.forename: Bao-gui
authors.initials: BG
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D000714:Anastomosis, Surgical / Q000379:methods*; D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery; D016896:Treatment Outcome