Simple versus double jejunal pouch for reconstruction after total gastrectomy

• Published in: The American journal of surgery 2000-07, Vol.180 (1), p.24-28
• Main Authors: Gioffre’ Florio, Maria A, Bartolotta, Marcello, Miceli, Joseph C, Giacobbe, Giuseppa, Saitta, Francesco P, Paparo, M.Teresa, Micali, Biagio
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anastomosis, Roux-en-Y; Anastomosis, Surgical - methods; Biological and medical sciences; Blood Proteins - analysis; Body Weight; Chemotherapy; Chi-Square Distribution; Eating; Endoscopy; Esophagus; Female; Follow-Up Studies; Food intake; Gastrectomy; Gastrectomy - rehabilitation; Gastrointestinal surgery; Hemoglobin; Hemoglobins - analysis; Humans; Jejunum - surgery; Longitudinal Studies; Male; Medical sciences; Middle Aged; Nutrition; Nutritional Physiological Phenomena; Nutritional status; Patients; Postgastrectomy Syndromes - prevention & control; Prospective Studies; Proteins; Quality of Life; Reconstructive surgery; Recovery of function; Serum albumin; Serum Albumin - analysis; Serum proteins; Small intestine; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(00)00419-0

Background: Even though many types of reconstruction after total gastrectomy have been proposed to reduce postgastrectomy syndromes, choosing a method that would further improve the quality of life and nutrition of the gastrectomized patient is controversial. Hunt-Lawrence single pouch reconstruction seems to obtain better results compared with the more common Roux-en-Y technique, but both of these reconstructive approaches are associated with some reduction in food intake and some problems in achievement of ideal body weight. Methods: In this prospective, randomized trial, after total gastrectomy 18 patients had reconstruction according to the Hunt-Lawrence or single pouch technique (SP group), whereas for 23 patients, the technique was modified with construction of a second pouch in the distal portion of the jejunal loop (DP group). Patients in the two groups were compared at 12 months after surgery for problems in gastrointestinal function, quality of life, improvement in body weight and nutritional parameters, serum albumin, hemoglobin level, and serum protein. Results: The DP group demonstrated fewer symptom problems, better weight maintenance, and better laboratory values when compared with patients undergoing standard single jejunal pouch reconstruction. Conclusions: Reconstruction with use of a double pouch as a gastric substitute leads to better outcome assessments than with a single pouch reconstruction. Our double pouch technique has demonstrated significant improvement in quality of life and nutritional recovery in terms of functional results as well as patient satisfaction.