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

Abstract

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.

Distal pouch reconstruction with transverse jejunoplasty after experimental gastrectomy

“…In addition, postoperatively, the formation of a pouch seems to be beneficial with regard to oral nutrient intake and weight gain, as weight loss in the pouch groups was significantly less than in the simple Roux-en-Y reconstruction group, which is consistent with other studies demonstrating better postoperative food intake and weight gain [11,12]. As pouch formation results in the reservoir function and decelerates food passage, this allows a more physiological digestion and absorption [13,14]. The additional jejunoplasty did not show a significant additional benefit.…”

Reverse Double-Stapling End-to-End Esophagogastrostomy in Proximal Gastrectomy

“…Esophagogastrostomy is the fastest and simplest method, however it is also known to cause severe gastroesophageal reflux in some patients. Some authors interpose a segment of the small bowel as a reservoir in a single row type or in a pouch type and reported that these interposition methods seemed to produce less reflux [21,22,23,24,25,26,27]. However, some unexpected serious complications by dilatation of the pouch were also noticed in the interposition methods [28,29].…”

Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan

“…Some reports supported the advantage of pouch reconstruction after total gastrectomy [17][18][19][20]. For example, Shibata et al [21] reported in their review article that six reports where pouch RY reconstruction was used showed improvements in body weight, QOL, eating capacity, and reflux symptoms compared to RY reconstruction without a pouch, while three reports showed no difference.…”