Long-term effects of jejunal pouch added to Roux-en-Y reconstruction after total gastrectomy

Miyoshi, Katsuhiko; Fuchimoto, Sadanori; Ohsaki, Toshihide; Sakata, Tetsu; Ohtsuka, Shinya; Takakura, Norihisa

doi:10.1007/pl00011739

Cited by 32 publications

(29 citation statements)

References 14 publications

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“…Bozzetti et al [28] reported that there were no differences in BW and eating habits between these 2 groups but that after JPRY-T, there were less gastrointestinal symptoms; although they concluded that there was no substantive benefit of pouch reconstruction, we classified their results as ‘positive’ according to our definition. The remaining 4 studies showed a benefit with JPRY-T in terms of eating capacity, food intake, BW, nutrition and symptoms [29,30,31,32]. When considered together, these 9 studies suggest that the postoperative results of JPRY-T are generally more favorable than those of RY-T.…”

Section: Resultsmentioning

confidence: 99%

Results of Reconstruction with Jejunal Pouch after Gastrectomy: Correlation with Gastrointestinal Motor Activity

Shibata

Ueno²,

Kakyou³

et al. 2009

Dig Surg

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Background/Aims: To investigate if restoration of esophago-intestinal or esophago-gastric continuity with a jejunal pouch after total or proximal gastrectomy has clinical benefits. Methods: We reviewed all relevant reports published after 1990 that dealt with the clinical results of reconstruction with a jejunal pouch after total and proximal gastrectomies and correlated those findings with results for gastrointestinal motility. Reports were chosen from a search of the literature using PubMed. Results: After total gastrectomy, the benefit of a jejunal J pouch interposition was not apparent compared to simple jejunal interposition; indeed, one trial concluded that simple interposition was better than pouch interposition in terms of food intake. In contrast, results with a jejunal J pouch during Roux-en-Y (RY) type reconstruction were better than with conventional RY reconstruction in terms of food intake, nutritional status, body weight (BW) and symptoms. Advantages were also shown for a jejunal pouch with an inverted U shape interposed between the esophagus and residual stomach after proximal gastrectomy. Reconstruction using a jejunal pouch after proximal gastrectomy was better than esophagogastrostomy or simple jejunal interposition in terms of food intake, BW and symptoms. There were not enough data to conclude any benefits of a jejunal J pouch between the gastric remnant and the duodenum after distal gastrectomy. Conclusions: Clinical results of restoration of intestinal continuity with a jejunal pouch after total and proximal gastrectomies may be attributed, at least in part, to the relationship between the motor activity of the gastric remnant, duodenum and jejunal pouch.

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Section: Resultsmentioning

confidence: 99%

Results of Reconstruction with Jejunal Pouch after Gastrectomy: Correlation with Gastrointestinal Motor Activity

Shibata

Ueno²,

Kakyou³

et al. 2009

Dig Surg

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show abstract

“…food stasis in the jejunal J pouch) and there are no advantages. 18,25 Ikeda et al showed that an adequate size is considered to be 15-20 cm in length, as determined scintigraphically. 25 In Japan, Tanaka et al reported that bending of a 20-cm jejunal pouch inhibits reservoir function, and recommended a 15-cm reconstruction with a double tract procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Miyoshi et al suggested that pouch reconstruction has the advantage of leading to a more favourable eating capacity to prevent microgastria and fewer postoperative symptoms, including loss of appetite, ARE and EDS. 18 There are some reports that pouch reconstruction can allow large meals that frequently reach preoperative levels. [22][23][24] However, an important problem in pouch reconstruction is how to determine an adequate size.…”

Section: Discussionmentioning

confidence: 99%

“…Second, it was also reported that the jejunal J pouch serves as a functional reflux barrier and food reservoir. [18][19][20][21] In addition, the function of the food reservoir leads to a slow food transit time and prevents EDS. Miyoshi et al suggested that pouch reconstruction has the advantage of leading to a more favourable eating capacity to prevent microgastria and fewer postoperative symptoms, including loss of appetite, ARE and EDS.…”

Section: Discussionmentioning

confidence: 99%

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Lower oesophageal sphincter‐preserving Roux‐en‐Y esophagojejunostomy with a jejunal J‐pouch reconstruction‐added His angle formation after total gastrectomy in patients with gastric cancer

Tomita

2018

Surgical Practice

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Aim:The aim of the present study was to prevent post-gastrectomy disorders (PGD), such as alkaline reflux esophagitis (ARE), early dumping syndrome (EDS) and microgastria, in patients after total gastrectomy for advanced gastric cancer. We performed lower oesophageal sphincter (LES)-preserving Roux-en Y with jejunal J-pouch reconstruction and His angle formation (LRYJPH). We introduce the application criteria, technical points and results of the LRYJPH procedure. Patients and Methods: Twenty-eight patients who underwent LRYJPH in our hospital from October 2014 to August 2015 were studied. The application criteria were gastric cancer patients (stages II, IIIA and IIIB) who could undergo radical surgery and tumour mainly localized at the middle third of the stomach, with its anal side 5.5 cm or further from the esophagogastric mucosa junction. To preserve the LES, the abdominal oesophagus was resected at the level of the His angle. To make a jejeunal J pouch, a plicated jejunal loop of 15 cm in length was made. After end-to-side esophagojejunostomy of the jejunal J pouch, a His angle was created on the left-side abdominal oesophagus. Results: The patient's appetite was unchanged compared with before the operation. Symptomatic and endoscopic ARE, food stasis in the jejunal J pouch and microgastria were all absent. EDS was 8.3 per cent. The level of satisfaction after the operation was 100 per cent. Conclusion: LRYJPH is appropriate to prevent PGD. This procedure is safe and facilities satisfactory results.

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“…Loss of body weight is a common sequela of gastrectomy; however, there has been no consensual explanation for the impact of gastrectomy on nutritional status (Miyoshi et al, 2001;Katai et al, 2003). Complex mechanisms seem to be involved, including abnormal transit and diarrhea (Takase et al, 2003), dumping syndrome (Schölmerich, 2004), reduced food intake because of early satiety and loss of appetite (Liedman et al, 2001;Bergh et al, 2003), and alteration of endocrine status, such as reduced ghrelin release (Date et al, 2000;Hosoda et al, 2006) or increased satiety mediators such as cholecystokinin (Bergh et al, 2003), PYY 3À36 (Stratis et al, 2006;Borg et al, 2007) or glucagon-like peptide-1 (Borg et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Ghrelin and PYY3−36 in gastrectomized and vagotomized patients: relations with appetite, energy intake and resting energy expenditure

et al. 2010

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Background/Objectives: Reduced food intake, appetite loss and alteration of ghrelin and PYY 3À36 secretion have been suggested to have a function in the loss of body weight commonly observed after gastrectomy. The objective of this study was to investigate the circulating concentrations of ghrelin and PYY 3À36 and their relationships with food intake, appetite and resting energy expenditure (REE) after gastrectomy plus vagotomy. Subjects/Methods: Seven patients with total gastrectomy (TG), 14 with partial gastrectomy (PG) and 10 healthy controls were studied. Habitual food intake and REE was assessed; fasting and postprandial plasma total ghrelin, PYY 3À36 concentrations and appetite ratings were determined after ingestion of a liquid test meal. Results: Differently from PG and controls, fasting ghrelin correlated with REE, and a higher energy intake was observed in the TG group. Fasting plasma ghrelin concentrations were lower in TG compared with controls, and no ghrelin response to the meal was observed in either PG or TG. Fasting plasma PYY 3À36 concentrations were not different among the groups. There was an early and exaggerated postprandial rise in PYY 3À36 levels in both PG and TG groups, but not in controls. No effect of ghrelin or PYY 3À36 concentrations was observed on hunger, prospective consumption or fullness ratings. Conclusions: Total ghrelin and PYY 3À36 do not seem to be involved with appetite or energy intake regulation after gastrectomy plus vagotomy. Ghrelin secreted by sources other than stomach is likely to have a function in the long-term regulation of body weight after TG.

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Long-term effects of jejunal pouch added to Roux-en-Y reconstruction after total gastrectomy

Cited by 32 publications

References 14 publications

Results of Reconstruction with Jejunal Pouch after Gastrectomy: Correlation with Gastrointestinal Motor Activity

Results of Reconstruction with Jejunal Pouch after Gastrectomy: Correlation with Gastrointestinal Motor Activity

Lower oesophageal sphincter‐preserving Roux‐en‐Y esophagojejunostomy with a jejunal J‐pouch reconstruction‐added His angle formation after total gastrectomy in patients with gastric cancer

Ghrelin and PYY3−36 in gastrectomized and vagotomized patients: relations with appetite, energy intake and resting energy expenditure

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