Jejunal pouch reconstruction after total gastrectomy for cancer : a randomized controlled trial

• Published in: Annals of surgery 1995-07, Vol.222 (1), p.27-35
• Main Authors: NAKANE, Y, OKUMURA, S, AKEHIRA, K, OKAMURA, S, BOKU, T, OKUSA, T, TANAKA, K, HIOKI, K
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anastomosis, Roux-en-Y - adverse effects; Anastomosis, Roux-en-Y - methods; Biological and medical sciences; Body Weight; Eating; Female; Gastrectomy - methods; Humans; Jejunum - diagnostic imaging; Jejunum - physiology; Jejunum - surgery; Male; Medical sciences; Middle Aged; Nutritional Status; Postoperative Care; Preoperative Care; Prognosis; Radionuclide Imaging; Stomach Neoplasms - surgery; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-199507000-00005

The authors determined the optimum reconstruction procedure after total gastrectomy in terms of the quality of life of the patients. Gastric replacement with various enteric reservoirs has been used to improve the postprandial symptoms and nutrition of patients after total gastrectomy. However, the effect of each is uncertain because no prospective randomized studies have been conducted. A randomized controlled trial was conducted to compare the usefulness of the three reconstruction procedures of simple Roux-en-Y (RY; N = 10), pouch and Roux-en-Y (PR; N = 10), and pouch and interposition (PI; N = 10). In each subject, the postprandial symptoms, food intake in a single meal, body weight, serum nutritional parameters, and emptying time of the gastric substitute were evaluated. The PR group showed significantly greater food intake in a single meal than the RY and PI groups, and greater weight recovery than the PI group. A gastric emptying test also revealed satisfactory retention capacity and emptying time of the gastric substitute in the PR group. Pouch and Roux-en-Y reconstruction is the most useful of the three procedures for improving the postoperative quality of life. In patients with pouch and interposition reconstruction, the clinical assessment was quite poor, even though it is a physiologic route.