Ileocecal Interpositional Graft as Gastric Replacement After Total Gastrectomy and Distal Esophagectomy

Flüe, Markus von; Metzger, Jürg; Harder, F.

doi:10.1001/archsurg.1997.01430330104019

Cited by 17 publications

(6 citation statements)

References 13 publications

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“…Using IIG in two patients, von Flüe [14] reported that reflux was not provoked even in the anti-Trendelenburg position. Pediatric surgeons have reported excellent results in replacing the entire esophagus with the retrosternal ileocolonic conduit.…”

Section: Discussionmentioning

confidence: 97%

“…Hunnicutt [12] performed 4 operations on humans with minimal risks. The ileocecal segment has rarely been used with this finality, but some studies have reported good results in children [13] and in adults [14][15][16][17]. In this study we tested two interpositional pouches with reestablishment of the duodenal passage, whose advantages have been frequently described [7,20].…”

Section: Discussionmentioning

confidence: 99%

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Comparing Reconstruction With Ileocecal Graft to Jejunal Interposition Pouch After Total Gastrectomy in Rats

Medeiros¹,

Filho²,

Medeiros³

et al. 2007

Journal of Investigative Surgery

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After total gastrectomy, the ileocecal graft may act as a reservoir and protect against reflux but give rise to transposition of the ileum and cause possible changes in bile acid metabolism and nutrition. This study compared the ileocecal graft and jejunal pouch. Male Wistar rats weighing 265 +/- 22 g were submitted to sham operation (S), ileocecal interposition graft (IIG), and jejunal pouch interposition graft (JP) after total gastrectomy. Eight weeks later, the esophagus was examined for evidence of esophagitis. Nutritional biochemistry and weight profile were documented preoperatively and 8 weeks after surgery. The oral glucose tolerance test was performed. Thirty-three rats were operated on and 30 survived for 8 weeks. Esophagitis occurred in seven JP rats. Body weight was significantly higher in IIG than in JP rats (p < .05). Normal glucose tolerance to intragastric glucose load was observed in sham and operated rats. JP rats had a significant decrease in serum albumin, glucose, transferrin, hemoglobin, iron, folate, and calcium, compared to sham (p < .05). Cobalamine was significantly lower in IIG rats than in JP rats (p < .05). In the IIG and JP groups, serum/hepatic total bile acid did not differ significantly from preoperative and sham values. In conclusion, the IIG interposition graft in rats prevented esophagitis, preserved nutrition, and did not interfere with enterohepatic total bile acid circulation.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Comparing Reconstruction With Ileocecal Graft to Jejunal Interposition Pouch After Total Gastrectomy in Rats

Medeiros¹,

Filho²,

Medeiros³

et al. 2007

Journal of Investigative Surgery

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“…It has also been used as a substitute for stomach and distal esophagus replacement[ 14, 15]. Ileocecal interposition has been demonstrated not to alter gastrointestinal transit [16].…”

Section: Discussionmentioning

confidence: 99%

Modified Ileocecal Interposition – The Final Sphincter-Saving Solution after Failed Salvage Surgery for Anastomotic Complications of Low Anterior Resection

Rink

Vestweber²,

Vestweber³

2008

Dig Surg

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Introduction: Reversal of low Hartmann’s procedures can be a challenging operation. We report on the successful treatment of patients who have already had prior salvage surgery for complications of a low colorectal anastomosis presenting with active fistulas from the rectal remnant. Methods: An ileocolic segment was mobilized with the neurovascular pedicle of the ileocolic artery and turned counterclockwise into the pelvis. The fistulas were cured and a hand-sutured coloanal anastomosis was performed at the level of the dentate line. Almost the entire length of the remnant colon was preserved. Results: There was no morbidity. The functional outcome was good or reasonable and the subjective satisfaction with the outcome was very high. Conclusion: We conclude that an ileocolic segment is an excellent substitute for reversal of low Hartmann’s procedures even in patients in whom prior salvage surgery has failed. As the functional outcome is slightly inferior to other alternatives for rectal replacement, its use should be restricted to patients with complex local situations or in whom alternative reconstructions would result in significant loss of bowel length.

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“…However, in the surgical technique of Maki et al [4] alkaline esophagitis due to reflux of duodenal juice was reported because LES was removed, though the pyloric sphincter was preserved. In addition, there were cases with reflux symptoms in which the food content that flowed into the interpositioned jejunum flowed back into the esophagus, and cases in which microgastria occurred because of decreased retention due to single jejunal crus, and therefore, many cases have been reported with low QOL [1,8,[12][13][14][15][16]. The authors attempted to preserve LES in addition to the surgical technique of Maki et al [4].…”

Section: Discussionmentioning

confidence: 99%

Operative Technique on Nearly Total Gastrectomy Reconstructed by Interposition of a Jejunal J pouch with Preservation of Vagal Nerve, Lower Esophageal Sphincter, and Pyloric Sphincter for Early Gastric Cancer

et al. 2001

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Nearly total gastrectomy preserving the vagal nerve, the lower esophageal sphincter (LES), and the pyloric sphincter was developed as a function-preserving surgical technique to improve postgastrectomy disorders. In this paper, application criteria and technique are outlined, and postoperative quality of life was clinically investigated. Ten subjects who underwent this surgical operation (group A: 7 male and 3 female subjects at age 48 to 68 years with a mean age of 58.3 years) were interviewed to inquire about reflux esophagitis, dumping syndrome, and microgastria. Group A was compared with 20 cases of conventional total gastrectomy with D2 lymphadenectomy, excision of the lower esophageal sphincter (LES), total vagotomy, and single jejunal interposition (group B: 16 male and 4 female subjects at age 48 to 72 years with a mean age of 63.9 years). Included were cases with early cancer (M or SM1 of N0) localizing at the middle third and lower stomach, which was not applicable to endoscopic excision of gastric mucosa or partial gastric excision in M cancer, 2 cm or farther from the margin of the cancer to the esophagogastric mucosa cephalad junction and 3.5 cm or farther from the margin of the cancer to the pyloric caudad sphincter; in SM1 cancer, 4 cm or farther from the oral-side margin of the cancer to esophagogastric mucosa junction and 5.5 cm or farther from the anal-side margin of the cancer to the pyloric sphincter. In excision with lymph nodes, hepatic and celiac branches bifurcating from anterior and posterior trunks of the vagal nerve were preserved. To preserve LES, the esophagus was severed at the His angle at right angle to the longitudinal axis of the esophagus. The antrum was severed at 1.5 cm from the pyloric sphincter, preserving the arteria supraduodenalis. An alternative gaster was created as a 15-cm jejunal pouch with a 5-cm jejunal conduit for orthodromic peristaltic movement, using an automatic suture instrument to complete side-to-side anastomosis of folded jejunum with 1- to 1.5-cm long upper end of the pouch not anastomosed. The abdominal esophagus was mechanically anastomosed with a jejunal J pouch, and anastomosis of the pyloric antrum with a jejunal conduit was manually completed by stratum anastomosis. In group A, food ingestion per time could be taken the same as that of a healthy person, with no reflux esophagitis and dumping syndrome being noticed. Reflux esophagitis developed more significantly in group B than in group A (p < 0.05). In food ingestion per time, group B was significantly delayed compared with group A (p < 0.05). The present results suggested that the surgical technique proposed is a function-preserving gastric surgery appropriate to prevent postgastrectomy disorder of subjects.

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Ileocecal Interpositional Graft as Gastric Replacement After Total Gastrectomy and Distal Esophagectomy

Cited by 17 publications

References 13 publications

Comparing Reconstruction With Ileocecal Graft to Jejunal Interposition Pouch After Total Gastrectomy in Rats

Comparing Reconstruction With Ileocecal Graft to Jejunal Interposition Pouch After Total Gastrectomy in Rats

Modified Ileocecal Interposition – The Final Sphincter-Saving Solution after Failed Salvage Surgery for Anastomotic Complications of Low Anterior Resection

Operative Technique on Nearly Total Gastrectomy Reconstructed by Interposition of a Jejunal J pouch with Preservation of Vagal Nerve, Lower Esophageal Sphincter, and Pyloric Sphincter for Early Gastric Cancer

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