Usefulness of reconstruction with jejunal pouch in total gastrectomy for gastric cancer in early improvement of nutritional condition

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.

Section: Resultsmentioning

confidence: 99%

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

Shibata

Ueno²,

Kakyou³

et al. 2009

“…Other authors [3, 4,6,7,8] also have reported the superiority of jejunal pouch reconstruction over the reconstruction without pouch from the point of view of eating capacity and nutritional status. Reconstruction preserving the duodenal food passage, interposition type or double-tract type, rather than the Roux-en-Y type is often recommended [4].…”

Section: Discussionmentioning

confidence: 99%

“…Reconstruction with a jejunal pouch after total gastrectomy has been reported to improve postoperative food intake and nutritional status as compared with conventional jejunal reconstruction [3,4,5,6,7,8]. The reconstruction that preserves duodenal food passage, interposition or double-tract type, is often recommended, but may be inferior to Roux-en-Y type in terms of preventing esophageal reflux of duodenal contents.…”

Section: Introductionmentioning

confidence: 99%

Antireflux Contrivance in Jejunal Pouch Reconstruction after Total and Proximal Gastrectomies

Ichikura

Chochi²,

Sugasawa³

et al. 2006

Background/Aim: In the reconstruction after gastrectomy, a jejunal pouch may be inferior as a gastric substitute to an isoperistaltic jejunum in terms of preventing reflux. We have developed an antireflux contrivance. Methods:A jejunal pouch was made by side-to-side anastomosis of both limbs of the jejunum folded into an inverted U, leaving a bridge of the jejunum 15 cm long at the top of the jejunal pouch (apical bridge). The apical bridge is cut near its oral end, and esophagojejunostomy is done, leaving the isoperistaltic jejunum 6–8 cm long positioned between esophagus and jejunal pouch. Results:This antireflux contrivance was performed in 37 patients undergoing total gastrectomy and in 22 patients undergoing proximal gastrectomy. There were no operative deaths in this series. Neither anastomotic bleeding nor anastomotic leakage were observed. In a questionnaire survey, 5 patients answered that they had had heartburn twice a week or more often, but the answer was not repeated by any patient. On endoscopic examination, all patients but 1 had normal findings for the esophagus. Mild esophagitis was observed in 1 patient. Conclusion:The antireflux contrivance reported here can be easily, safely, and uniformly done, and it is a useful technique.

“…By contrast, total gastrectomy is a common procedure in patients with both early and advanced gastric cancers, and several studies have focused on optimizing the reconstruction technique [15,16,17]. To prevent various difficulties due to esophagogastrostomy after proximal gastrectomy, different techniques of anastomosis have been advocated, including jejunal pouch interposition and jejunal interposition [7,8,18].…”

Section: Introductionmentioning

confidence: 99%

“…To prevent various difficulties due to esophagogastrostomy after proximal gastrectomy, different techniques of anastomosis have been advocated, including jejunal pouch interposition and jejunal interposition [7,8,18]. These interposition reconstruction methods after total or proximal gastrectomy have been reported to be useful against reflux esophagitis [16,17,18]. Another investigation found that jejunal pouch interposition was effective in the preservation of gastric function after proximal gastrectomy, although the number of patients in the study was limited [19].…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study Comparing Jejunal Pouch and Jejunal Interposition Reconstruction after Proximal Gastrectomy

Takagawa

Kunisaki²,

Kimura³

et al. 2010

Background/Aims: The incidence of proximal gastric cancer is increasing, so proximal gastrectomies are often performed to preserve gastric function, but the optimal reconstruction method after surgery remains controversial. We therefore conducted a prospective pilot study comparing reconstructions using jejunal pouch interposition or jejunal interposition. Methods: Thirty-eight patients with early proximal gastric cancer were included in this study. Equal numbers of patients were randomly assigned for reconstruction using jejunal interposition (the IP group) or jejunal pouch interposition (the PO group). Postoperative morbidity and patient symptoms were compared between the 2 groups. Results: Postoperative morbidity was significantly more frequent in the IP than the PO group (p = 0.036). Moreover, the incidence of gastrointestinal complaints was more frequent in the IP group until 6 months after surgery. By contrast, the caloric intake was more favorable in the PO group until 1 year post-surgery. Conclusion: Short-term and mid-term outcomes were more favorable following jejunal pouch interposition compared with jejunal interposition after proximal gastrectomy.