Double Tract Reconstruction (DTR) - An Alternative Type of Digestive Tract Reconstructive Procedure After Total Gastrectomy - Own Experience

Khoshnevis

Journal of Gastrointestinal Surgery

2015

Section: Discussionmentioning

confidence: 99%

Novel Jejunoduodenostomy Technique for Prevention of Duodenal Stump Blowout Following Gastrectomy

Khoshnevis

Journal of Gastrointestinal Surgery

2015

Gastric Cancer - An Update

“…In this RP after TG, the duodenum in the first act remains open, and after the creation of an esophagojejunal anastomosis according to the principles of the operational technique of carrying RY configurations with a duodenum duct, an additional distal end-to-side jejunoduodenal anastomosis is established at about 20 cm distal from created esophagojejunal anastomosis [30]. Today's modification of the originally described technique is the creation of end-to-end duodenal anastomosis at 35-40 cm distal from esophagojejunal anastomosis [31]. Creation of distal termino-lateral jejunojejunal anastomosis is performed according to the principles of the original RY configuration of esophagojejunostomy at about 60 cm from end-to-side or end-to-end esophagojejunal anastomosis ( Figure 6).…”

Section: Esophagojejunostomy Roux-en-y Double Tract Configurationmentioning

confidence: 99%

“…Creation of distal termino-lateral jejunojejunal anastomosis is performed according to the principles of the original RY configuration of esophagojejunostomy at about 60 cm from end-to-side or end-to-end esophagojejunal anastomosis ( Figure 6). Creation of esophagojejunal anastomosis is performed by a manual two-layer suture technique or the use of the CEEA circular surgical stapler, while the creation of jejunoduodenal and jejunojejunal anastomosis is performed by a manual two-layer suture technique (Figure 7) [31,32]. The RY configuration of the DT is now applied in some institutions in Japan.…”

Section: Esophagojejunostomy Roux-en-y Double Tract Configurationmentioning

confidence: 99%

“…At the same time, the procedure for gastric reconstruction should be technically easily performed with minimal postoperative complications. RP that meet these requirements are those with the preservation of DP RY configuration of DT, Longmire procedure for the esophagus interposition of the jejunal segment, as well as the procedure of interposition with the jejunal pouch (e.g., Hunt-Lawrence pouch) [31]. Reconstructive Procedures after Total Gastrectomy for Gastric Cancer http://dx.doi.org/10.5772/intechopen.75591…”

Section: Advantages Of Reconstructive Procedures With Preservation Dumentioning

confidence: 99%

“…Schematic representation of reconstruction after TG with DP by Longmire, by interposition of jejunal segment with the creation of end-to-end esophagojejunostomy and end-to-end jejunoduodenostomy.Gastric Cancer -An Update of the intestinal continuity with the Longmire's jejunal interposition provides theoretical advantages over the reconstruction of the RY configuration[31].…”

mentioning

confidence: 99%

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Reconstructive Procedures after Total Gastrectomy for Gastric Cancer

Ignjatović¹,

Randjelović²,

Stojanović³

et al. 2019

Till this day, there are more than 60 described surgical procedures of the intestinal reconstructions after a total gastrectomy. In 1897, Schlatter reconstructed the digestive tract by creating a termino-lateral esophagojejunostomies that was the first successful total gastrectomy. Many of the total gastrectomy pioneers did the reconstruction by esophagoduodenostomy or by forming a loop esophagojejunostomy. The main reconstruction modalities after a total gastrectomy are a restitution of the intestinal continuity, without a preservation of the duodenal food passage (esophagojejunostomy with a Roux-en-Y configuration) and a restitution of the intestinal continuity with a preservation of the duodenal passage (esophagojejunostomy with Roux-en-Y configuration and forming of the lateral-terminal jejunoduodenal anastomosis double tract and jejunal interposition by Longmire). The surgeries in these categories can be combined with forming of an enteral pouch or a stomach reservoir which would simulate a reservoir of a normal intact stomach. The ideal reconstruction procedure after total gastrectomy should replace all lost functions of the stomach. Preservation of duodenal transit with replacement of the jejunal segment, the so-called physiological route, is now believed to be preferential for postoperative nutritional condition, prevents persistent postgastrectomy syndrome, and improves the quality of life. Reconstructive procedures which allow duodenal passage should be regarded as a key to physiological reconstruction.

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

A Comparative Study of Double-Tract Reconstruction and Roux-en-Y After Gastrectomy for Gastric Cancer

Hong

Wang

Hao

2019

Background: The meta-analysis was performed to compare surgical and functional results of double-tract (DT) and Roux-en-Y (RY) reconstruction, applied in both partial and total gastrectomy. Methods: PubMed, Ovid, Web of Science, Wiley, EBSCO, and the Cochrane Library Central were searched for studies comparing DT and RY after partial or total gastrectomy. Surgical, nutritional, and long-term outcomes were collected and analyzed.Results: A total of 595 patients from 8 studies were included. Operative time, time to first flatus, length of hospital stays, complications, postoperative nutritional variables, and functional result were similar between 2 groups. Group DT had significantly less blood loss, shorter time to oral intake and less loss of body weight at 2 years after operation.Conclusions: DT reconstruction is comparable with RY after gastrectomy in safety, surgical outcomes including reflux symptom and postoperative recovery and shows better food intake and body weight maintenance.