Food intake after gastrectomy for gastric carcinoma: The role of a gastric reservoir

Abstract

Patients with carcinoma of the stomach who underwent curative resection were randomized to total gastrectomy (n = 49), total gastrectomy and an S-shaped gastric substitute (n = 28) or subtotal gastrectomy (n = 12); all had a Roux-en-Y reconstruction. The gastric substitute and gastric remnant allowed a volume of 400-500 ml to be installed without increments in basal pressures. The corresponding volume in the Roux limb was 100 ml. Energy intake was approximately 120 kJ/kg preoperative weight per day 3 months after operation, and then remained constant. Patients who had subtotal gastrectomy ate less (91.7 kJ/kg preoperative weight) 3 months after operation, but thereafter increased their intake. Patients allocated to have a gastric pouch or subtotal gastrectomy complained more frequently of adverse postprandial symptoms (P < 0.03) as a major cause of reduced calorie intake. The construction of a gastric reservoir did not improve nutritional adaptation after surgery for gastric carcinoma.

Optimal gastric pouch reconstruction post-gastrectomy

“…The smaller pouches (5 and 10 cm) were unable to achieve such volumes at basal and intermediate pressures, i.e., pressures that would be tolerated by patients without experiencing satiety. With the smaller pouches, in excess of 350 ml was only attainable with distending pressures of 45 cmH 2 O, at which stage patients would experience troublesome symptoms such as epigastric pain, nausea, and vomiting, in accordance with work carried out by Liedman et al [18]. However, the larger pouches (15 and 20 cm) achieved the desired volume at basal and intermediate pressures which could be tolerated by patients without adverse side effects.…”

“…Liedman et al [18] demonstrated that intragastric/pouch pressures approaching 15 cmH 2 O were tolerated by patients without experiencing symptoms of satiety; whereas higher pressures approaching 45 cmH 2 O were poorly tolerated by patients, resulting in epigastric pain, nausea, and vomiting. An average meal size in elderly patients equates to 350-400 ml, according to data gathered from our unit.…”

Long-term changes in gut hormones, appetite and food intake 1 year after subtotal gastrectomy with normal body weight

“…One could expect that after total gastrectomy, loss of the gastric reservoir reduces calorie intake, which is a major cause of weight loss (Liedman et al, 1996). However, after subtotal gastrectomy, no significant difference in food intake was found preoperatively and 1 year after surgery.…”

Comparing aboral versus oral pouch with preserved duodenal passage after total gastrectomy: does the position of the gastric substitute reservoir count?

“…Randomized studies published in this fi eld mainly question the importance of reservoir construction [1,[9][10][11][12][13][14][15][16][17][18][19][20][21][22]; fewer trials research the importance of duodenal passage preservation [11,14,[23][24][25][26]. Two expert reviews have been published, each trying to draw evidence-based conclusions by means of a metaanalysis of all available randomized trials [27,28].…”