title: Early dumping syndrome and reflux esophagitis prevention with pouch reconstruction.
abstract: BACKGROUND
  Total gastrectomy causes numerous disorders, such as reflux esophagitis, dumping syndrome, malabsorption, and malnutrition. To minimize the consequences, different variants of reconstruction are performed. The aim of our study is the comparison of two reconstructive methods: the standard Roux-en-Y and a new modality of pouch interposition, preduodenal-pouch interposition. This study aims to investigate the advantage of bile reflux prevention and to reduce symptoms of dumping syndrome after 3- and 6-mo follow-up.
  
  
  METHODS
  A total of 60 patients were divided in two groups: (A) 30 patients with Roux-en-Y reconstruction, and (B) 30 patients with the preduodenal-pouch (PDP) type of reconstruction. Endoscopic examination and endoluminal jejunal limb pressure measurements were performed. Scintigraphic measurements of half-emptying time were performed to evaluate meal elimination in the context of reflux esophagitis and early dumping syndrome. The Japan Society of Gastrointestinal Surgery has provided guidelines with which to classify the symptoms of early dumping syndrome. Patients were followed up for periods of 3 and 6 mo after the surgery.
  
  
  RESULTS
  Our study groups did not differ with regard to the level of reflux esophagitis (P = 0.688). Average values of pressure at 10 and 15 cm below the esophago-jejunal junction were significantly lower in the PDP group (P < 0.001). Elimination of the test meal between two groups was not significant (P = 0.222). Evaluation of early dumping syndrome symptoms revealed a significant reduction among PDP patients after 3 and 6 mo.
  
  
  CONCLUSIONS
  Our study showed significant superiority of the new pouch reconstruction over the standard Roux-en-Y approach in the treatment of early dumping syndrome.
authors.affiliation: Department of Esophago-Gastric Surgery, KBC Bezanijska kosa, Belgrade, Serbia. srdjan_dikic@yahoo.com
authors.forename: Srdjan
authors.initials: S
authors.lastname: Dikic
authors.forename: Tomislav
authors.initials: T
authors.lastname: Randjelovic
authors.forename: Svetlana
authors.initials: S
authors.lastname: Dragojevic
authors.forename: Dragoljub
authors.initials: D
authors.lastname: Bilanovic
authors.forename: Miroslav
authors.initials: M
authors.lastname: Granic
authors.forename: Dragan
authors.initials: D
authors.lastname: Gacic
authors.forename: Darko
authors.initials: D
authors.lastname: Zdravkovic
authors.forename: Branislav
authors.initials: B
authors.lastname: Stefanovic
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Djokovic
authors.forename: Vladimir
authors.initials: V
authors.lastname: Pazin
mesh_terms: D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004377:Dumping Syndrome / Q000209:etiology / Q000517:prevention & control; D004942:Esophagitis, Peptic / Q000209:etiology / Q000517:prevention & control; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000209:etiology / Q000517:prevention & control*; D019651:Plastic Surgery Procedures; D013274:Stomach Neoplasms / Q000601:surgery*