Effects of creating a jejunal pouch on postoperative quality of life after total gastrectomy: A cross‐sectional study

Abstract

Aim Total gastrectomy results in the complete loss of gastric function and the development of severe postgastrectomy syndrome. During the jejunal pouch procedure following total gastrectomies, a substitute stomach is created to alleviate the effects of postgastrectomy syndrome. However, the procedure's effectiveness remains controversial. This study aimed to explore the effect of jejunal pouch creation after total gastrectomy on postoperative quality of life. Methods A nationwide multi‐institutional cross‐sectional study, the Postgastrectomy Syndrome Assessment study NEXT, used the Postgastrectomy Syndrome Assessment Scale‐45 questionnaire to explore the optimal gastrectomy procedure for cancer located in the upper third of the stomach or around the esophagogastric junction. The questionnaire consists of 45 items consolidated into 19 main outcome measures relating to postgastrectomy symptoms, amount of food ingested, quality of ingestion, ability for working, level of satisfaction for daily life, and the physical and mental component summary of the 8‐Item Short Form Health Survey. Eligible completed questionnaires were retrieved from 1909 patients. Of these, the data were analyzed for 1020 patients who underwent total gastrectomy and 93 patients who underwent jejunal pouch creation after total gastrectomy. Results Postoperative quality of life was compared between patients with and without pouches. The analysis revealed that patients with pouches, particularly oral pouches, experienced substantially improved postoperative quality of life than those without, even after adjusting for several clinical factors using multiple regression analyses. Conclusion The results suggest that total gastrectomy with jejunal pouch creation, particularly oral pouches, may significantly improve postoperative quality of life.

Effect of Four Main Gastrectomy Procedures for Proximal Gastric Cancer on Patient Quality of Life: A Nationwide Multi-Institutional Study

“…Postoperative QOL in PG [ 10 11 12 ], SRDG [ 13 14 15 ], and TGJP [ 16 17 18 19 ] have been reported to be higher than in TG. Based on this study, the PGSAS NEXT study found that postoperative QOL was better with PG [ 29 ], SRDG [ 30 ], and TGJP [ 31 ] than with TG, even after adjusting for the effects of various confounders using multiple regression analysis, supporting a previous report. However, no study has simultaneously compared these procedures for proximal gastric cancer to determine the severity and characteristics of their impact on postoperative QOL.…”

Impact of the Aboral Pouch in Roux-en-Y Reconstruction after Laparoscopic Total Gastrectomy for Elderly Patients

“…Both methods often use a linear stapler to add to the reconstruction. There is no fixed definition of pouch size or method for creating the pouch; however, in practice, a more convenient aboral pouch is likely to be preferred 8,11,18) .…”

“…Weight loss after total gastrectomy occurs in approximately 10-15% of cases. Decreased food intake and esophageal reflux symptoms due to bile reflux are particularly well-known causes [5][6][7][8] . Several reconstructive innovations reportedly improve PGS and QOL postoperatively in patients who have undergone total gastrectomy procedures.…”

“…Several reconstructive innovations reportedly improve PGS and QOL postoperatively in patients who have undergone total gastrectomy procedures. However, the best practice has not yet been established 8,9) .…”

“…One method known to improve the reservoir capacity function after total gastrectomy is the addition of a jejunal pouch to the reconstruction. This pouch, created in the Y limb of Roux-en-Y reconstruction, is called the aboral pouch 8,10,11) . Despite several reports on the usefulness of aboral pouches, there is no consensus regarding the safety and benefits of aboral pouches in elderly patients.…”