Left Colon Substitution with His’ Angle following Total Gastrectomy

Ohwada, Susumu; Ogawa, Tetsushi; Nakamura, Seiji; Satoh, Yoshihiro; Takeyoshi, Izumi; Iwazaki, Shigeru; Izumi, Masaru; Iino, Yuichi; Morishita, Yasuo

doi:10.1159/000018687

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…The broad spectrum of reconstruction methods can be subdivided into those excluding the duodenal passage with or without pouch construction, and others restoring the duodenal passage with or without pouch construction [6, 7]. The construction of a gastric pouch provides an increased reservoir capacity, a higher amount of calories ingested by the patient.…”

Section: Discussionmentioning

confidence: 99%

Aboral Pouch with Preserved Duodenal Passage – New Reconstruction Method after Total Gastrectomy

Horváth

Kalmár²,

Cseke³

2002

Dig Surg

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A new reconstruction method – the aboral pouch with preserved duodenal passage – has been introduced after total gastrectomy. After removal of the stomach, preparation of the Roux loop and construction of the esophago-jejunostomy, a jejuno-duodenostomy is performed approximately 50 cm away from the esophageal anastomosis between the Roux limb and the duodenal stump. Right below this second anastomosis, the Roux limb is closed with a stapling device to provide a unidirectional food passage through the duodenum. The aboral pouch is constructed as a side-to-side anastomosis between the Roux limb under the stapled segment and the aboral end of the Y limb. The advantages of the reservoir-constructing methods and the interposition methods are combined in this new reconstruction type. Our experiences of 17 cases having undergone this reconstruction method are presented.

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Section: Discussionmentioning

confidence: 99%

Aboral Pouch with Preserved Duodenal Passage – New Reconstruction Method after Total Gastrectomy

Horváth

Kalmár²,

Cseke³

2002

Dig Surg

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“…The purpose of creating a pouch was to increase food ingestion as well as to enable the temperature of ingested food to approach the body temperature so that the contents may be well mixed with orally administered digestive enzymes [16]. For creation of the pouch, there are techniques available using ileocolon [14,15] and transverse colon [13]. The authors adopted the jejunal J pouch technique because it is easy to create.…”

Section: Discussionmentioning

confidence: 99%

“…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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“…Since direct anastomosis between the esophagus and the remnant stomach resulted in severe reflux esophagitis, jejunal interposition or Roux-en-Y esophagojejunostomy with side-to-end jejunogastrostomy (double-tract method) has been employed. Recently, gastric substitutes with sufficient capacity for food have been made by the interposition of a jejunal pouch [4,5,16] or a short segment of left colon [17]. Although these gastric substitutes are reported to be useful, the procedures are complicated and timeconsuming, and need several stapling devices.…”

Section: Discussionmentioning

confidence: 99%

Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction

et al. 1999

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Abstract:Background. The frequency of tumors in the upper one-third of the stomach has been increasing. The standard operation for proximal gastric cancer has been total or proximal gastrectomy. The aim of this study was to present the pathologic and surgical results of 30 patients with early-stage proximal gastric cancer managed by proximal gastrectomy. Methods. A consecutive series of 30 patients who underwent proximal gastrectomy for early-stage proximal gastric cancer was studied. Sixteen patients underwent jejunal interposition, while 14 underwent gastric tube reconstruction, which consisted of a direct anastomosis between the esophagus and the remnant of the tube-like stomach. Results. Twenty patients (67%) had no abdominal symptoms and the lesions were detected by screening gastric fiberscopy. The tumors were mostly located along the lesser curvature (73%), were grossly depressed type (IIc) (70%), and histologically well differentiated type (63%). The depth of wall invasion was the mucosa in 12 patients, submucosa in 15, and muscularis propria in 3; lymph node metastasis was absent in 28 patients (93%). When compared with patients with jejunal interposition, patients with gastric tube reconstruction had a shorter operation time (327 vs 165 min), less blood loss (508 vs 151 g), and shorter hospital stay after operation (31 vs 17 days). Endoscopy and 24-h pH monitoring showed no evidence of reflux esophagitis, except in 1 patient with gastric tube reconstruction, and no patient died of recurrence. Conclusions. Early-stage proximal gastric cancer can be successfully treated by proximal gastrectomy. Since gastric tube reconstruction is a simple, easy, and safe procedure, proximal gastrectomy followed by gastric tube reconstruction is recommended for patients with early-stage proximal gastric cancer. Offprint requests to: Y. Adachi

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Left Colon Substitution with His’ Angle following Total Gastrectomy

Cited by 7 publications

References 19 publications

Aboral Pouch with Preserved Duodenal Passage – New Reconstruction Method after Total Gastrectomy

Aboral Pouch with Preserved Duodenal Passage – New Reconstruction Method after Total Gastrectomy

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

Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction

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