title: Nutritional insight into preduodenal pouch reconstruction one year after total gastrectomy.
abstract: BACKGROUND
  Various types of reconstructions have been developed to improve the quality of life of patients following total gastrectomy. In addition, to ensure larger food-intake reservoirs and extend meal transit times, different types of pouch reconstructions have been developed and described. Our opinion is that the most important factor in providing better physiologic regulation of ingested food is restoration of the duodenal passage and enlargement of the gastric substituent.
  
  
  METHODS
  In the present study, we compared standard a Roux-en-Y reconstruction and a preduodenal pouch (PDP) reconstruction. We evaluated the quality of life (QoL) for 60 patients during the first postoperative year, comparing serum albumin, protein, hemoglobin, iron, body weight, body mass index, and QoL. QoL was defined according to Korenaga's score scale, which has 14 questions, for better understanding of subjective patient perceptions of digestive function.
  
  
  RESULTS
  Our study population did not differ in iron and hemoglobin levels at a 1-y follow-up. The difference between total serum albumin level was significant in all observed patients in the follow-up period in favor of the PDP reconstruction group (P = 0.001). The PDP reconstruction group also had a significantly higher serum protein level after 12 mo. The higher score difference between the two groups generally confirm the improved QoL in the PDP group (P = 0.001).
  
  
  CONCLUSIONS
  The most important aspects of improved QoL after gastrectomy due to gastric carcinoma are maintenance of the duodenal transit and the addition of a pouch. Jejunal preduodenal pouches provide a better QoL than Roux-en-Y reconstruction. Our study results suggest preduodenal pouch reconstruction should be used as the method of choice.
authors.affiliation: Department of Esophagogastric surgery, Medical School, University of Belgrade, Serbia, Radoja Domanovica 19, 11000 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: Dragan
authors.initials: D
authors.lastname: Gacic
authors.forename: Dragoljub
authors.initials: D
authors.lastname: Bilanovic
authors.forename: Vesna
authors.initials: V
authors.lastname: Vulovic
authors.forename: Igor
authors.initials: I
authors.lastname: Jovanovic
authors.forename: Spaso
authors.initials: S
authors.lastname: Andjelic
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D001835:Body Weight / Q000502:physiology; D004063:Digestion / Q000502:physiology; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology*; D011184:Postoperative Period; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery
chemical_list: D012709:Serum Albumin