title: J-pouch versus Roux-en-Y reconstruction after gastrectomy: functional assessment and quality of life (randomized trial).
abstract: OBJECTIVE
  The aim of this study was to evaluate the quality of life and functional emptying of J-pouch versus Roux-en-Y reconstruction after total gastrectomy for malignancy.
  
  
  METHODS
  This study was designed as a prospective, nonblinded, randomized, parallel clinical trial (Trial Number: MN Ostrava, 200604). With informed consent, patients undergoing gastrectomy for malignancy were randomized to J-pouch or Roux-en-Y reconstruction. The time taken for a test semisolid meal labeled with99mTc-sulfur colloid to exit the reconstructed parts was measured by dynamic scintigraphy 1 year after resection. Quality of life was measured using the Eypasch questionnaire at the same time as functional emptying assessment. This trial was investigator-initiated.
  
  
  RESULTS
  In all, 72 patients were included into the study. The time taken for the test meal to exit the postgastrectomy reconstruction was 16.5±10.0 minutes (mean ± standard deviation) in the Roux-en-Y group and 89.4±37.8 minutes in the "J-pouch" group; the difference was statistically significant (P<0.001). Emptying of the J-pouch appeared to be a linear decreasing function compared to the exponential pattern seen in the Roux-en-Y group. The quality of life measurement showed scores of 106±18.8 points (mean ± standard deviation) in the Roux-en-Y group compared to 122±22.5 points in the J-pouch group; the difference was statistically significant (P=0.0016). There were no important adverse events.
  
  
  CONCLUSIONS
  After total gastrectomy, a J-pouch reconstruction empties more slowly and is associated with higher quality of life compared to Roux-en-Y reconstruction. Whether these two observations have a direct causative link remains unanswered.
authors.affiliation: Department of Surgery, University Hospital Ostrava; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava.
authors.forename: Pavel
authors.initials: P
authors.lastname: Zonča
authors.affiliation: Department of Surgery, University Hospital Olomouc, Olomouc.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Malý
authors.affiliation: Department of Surgery, University Hospital Ostrava; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava.
authors.forename: Peter
authors.initials: P
authors.lastname: Ihnát
authors.affiliation: Department of Surgery, University Hospital Ostrava; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava.
authors.forename: Matus
authors.initials: M
authors.lastname: Peteja
authors.affiliation: Department of Nuclear Medicine, University Hospital Ostrava, Ostrava.
authors.forename: Otakar
authors.initials: O
authors.lastname: Kraft
authors.affiliation: Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava; Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Kamil
authors.initials: K
authors.lastname: Kuca
keywords: J-pouch; Roux-en-Y; dynamic scintigraphy; gastrectomy; gastric emptying; quality of life