Comparison of Functional Outcomes between Functional Jejunal Interposition and Conventional Roux-en-Y Esophagojejunostomy after Total Gastrectomy for Gastric Cancer

Abstract

Background: The reconstruction of digestive tract after total gastrectomy is associated with various postoperative complications. We aimed to investigate the differences in functional outcomes of 2 reconstruction techniques following total gastrectomy: functional jejunal interposition (FJI) versus Roux-en-Y esophagojejunostomy. Methods: Sixty patients were enrolled and divided into FJI and Roux-en-Y groups. Nutritional parameters and incidences of reconstruction-related symptoms were evaluated. Oral glucose tolerance test and endoscopy examination were carried out. Results: The postoperative prognostic nutritional index scores and postoperative/preoperative body weight, meal intake, serum albumin level ratio were significantly higher in the FJI group than in the Roux-en-Y group. At 3, 6, and 12 months postoperatively, the elevations of plasma glucose level after glucose intake were more significant in the FJI group than in the Roux-en-Y group. The incidence of post-operative stasis symptoms in the Roux-en-Y group was significantly higher than in the FJI group, but no obvious difference was observed regarding dumping and reflux symptoms. The incidence rates of severe esophageal mucosa injury and severe anastomotic stricture were also similar between the 2 groups. Conclusion: FJI reconstruction might accelerate the recovery of nutritional status and reduce the occurrence of stasis symptoms postoperatively as compared with Roux-en-Y esophagojejunostomy, which may have an advantage over FJI in stabilizing body glycometabolism after surgery. These 2 types of reconstruction may have a similar anti-reflux function to prevent severe reflux esophagitis and anastomotic stenosis.

Is jejunoduodenostomy better than jejunogastrostomy in laparoscopic gastrectomy with jejunal interposition ?

“…[3] Dumping syndrome which is manifested by abdominal distension and increased intestinal motility can be observed due to uncontrolled and rapid transit of food into the efferent loop. [2,5,6] Only one patient of the study group developed dumping syndrome. Jejunal interposition may be preferred for reconstruction after gastrectomy since postgastrectomy syndromes are less common.…”

“…[9] Thus, jejunal interposition ensures earlier recovery of postoperative nutritional status. [6,7] Less weight loss is seen in jejunal interposition compared to other reconstruction techniques. [2] Since jejunal interposition acts as a sphincter, it is thought to prevent reflux from the remnant stomach.…”

Double-tract vs gastric tube reconstruction after proximal gastrectomy in upper third gastric cancer: a Propensity Score Matching Analysis

“…A comparative study by Chen showed a re ux rate of 11.8% (n = 34) with gastric tube reconstruction [26] . The anti-re ux effect of JI and DT is achieved by inserting a segment of jejunum between the esophagus and the remnant stomach [27,28] , and DT has remnant stomach passage and jejunum passage, which can increase food intake and improve postoperative nutritional status [29] . Tanaka [30] et al thought that when most food intake pass through the jejunum passage rather than remnant stomach passage,the effect of DT will be similar to TG.…”

Assessing the Incidence of Postoperative Diabetes in Gastric Cancer Patients: A Comparative Study of Roux-en-Y Gastrectomy and Other Surgical Reconstruction Techniques

“…It has been found that long-limb Roux-en-Y bypass reconstruction could lead to improved glycemic control [25], and it has been observed that pre-existing diabetes is associated with postoperative complications [10, 26]. Several studies further support the benefits of Roux-en-Y reconstruction, with some indicating it to be more effective than Billroth II reconstruction [27, 28]. Additionally, significant improvements in diabetes control have been associated with Roux-en-Y reconstruction [25, 28].…”