Técnica de Rosanov modificada na reconstrução do trato digestivo após gastrectomia total

Abstract

-Background -Total gastrectomy in gastric cancer is a procedure not without early and late complications and type of reconstruction of the digestive tract to be used is still a controversial issue in literature. Aim -To describe a modified Rosanov technique after total gastrectomy, employed with the aim of minimizing the intestinal malabsorption and other complications following this procedure. Method -Technical modification is not to hold distal ligature on jejuno-duodenal anastomosis, thereby offering to the food transit two routes by the duodenum and by the jejunum. Results -There were no complications and the initial series showed a benefit in the nutritional aspects after six months of postoperative follow-up. Conclusion -It is a simple technique and preliminary results with its use were very satisfactory, although other clinical studies must be conducted to demonstrate the advantages of the technique in the long term. ABCDDV/786RESUMO -Racional -A gastrectomia total nas neoplasias gástricas é um procedimento não isento de complicações precoces e tardias e o tipo de reconstrução do trato digestivo a ser utilizado é ainda questão controversa na literatura. Objetivo -Descrever a técnica de Rosanov modificada, após a gastrectomia total, empregada com o objetivo de minimizar a má absorção intestinal e outras complicações após este tipo de procedimento. Métodos -A modificação técnica consiste de não realizar a ligadura distal à anastomose jejuno-duodenal, fazendo assim com que o trânsito alimentar tenha duas vias de passagens, pelo duodeno e pelo jejuno. Resultados -Não foram registradas complicações e a casuística inicial mostrou vantagens sob os aspectos nutricionais após seis meses de seguimento pós-operatório. Conclusão -É técnica de fácil execução e os resultados preliminares com o seu emprego foram muito satisfatórios, no entanto outros estudos clínicos devem ser realizados para demonstrar as vantagens da técnica a longo prazo.

Are There Advantages in Double Transit Reconstruction After Total Gastrectomy in Patients With Gastric Cancer? A Systematic Review

“…Over the years, more than 50 reconstruction models of the digestive tract after total stomach excision were proposed by various authors, indicating, on the one hand, the rich imagination of surgeons, but on the other hand, that there is no technique with universal acceptance. Cesar Roux deserves credit as in 1893 he described the RY reconstruction which is currently the most widely used by surgeons on all continents 2 , 17 , 18 .…”

“…It is still a controversial issue in clinical research, though, whether reconstruction after total gastrectomy for gastric cancer should be done with or without some type of reservoir or placement of the duodenum in the alimentary transit 7 , 17 , 18 , 37 .…”

“…The oldest reference found in the literature regarding the placement of the duodenum in the alimentary transit after total gastrectomy dates from 1958. It was a technique described by Rosanov, a Russian surgeon, performing reconstruction in RY with a latero-terminal jejuno-duodenal anastomosis 18 . Subsequently, in 1965, Kajitani et al 13 demonstrated the advantages of the technique in Japan.…”

“…Lopes et al 18 , in 2011, conducted laboratory and clinical evaluations on 43 patients who underwent total gastrectomy six months postoperatively. Among them, 32 had RY reconstruction, 11 underwent a modified Rosanov technique, a type of DT reconstruction, and 22 individuals served as a control group without surgery.…”

“…The alimentary transit through the duodenum can be accomplished through double transit (DT) reconstruction, starting with the RY reconstruction, followed by a side-end jejuno-duodenal anastomosis 18 ( Figure 1B and Figure 2 ). This technique has proven to be effective in reducing reflux symptoms and mixing bile and pancreatic juice with food, improving digestion and absorption.…”