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Jejunal pouch to avoid stricture after esophagojejunostomy with circular stapler
1Department of Surgery, Maizuru Municipal Hospital, Kyoto, Japan.
Journal of the American College of Surgeons
|November 5, 1999
Summary
Jejunal pouch reconstruction after total gastrectomy allows larger EEA instrument use, reducing anastomotic stricture and postprandial symptoms compared to Roux-en-Y. Nutritional status showed no significant difference.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Medical Devices
Background:
- Anastomotic stricture is a common complication following esophagojejunostomy after total gastrectomy.
- Current methods to alleviate stricture include scar incision, balloon dilatation, and steroid injection.
- Jejunal pouch reconstruction may facilitate the use of a larger end-to-end anastomosing (EEA) instrument, potentially preventing stricture.
Purpose of the Study:
- To investigate the efficacy of jejunal pouch construction with a large EEA in preventing anastomotic stricture.
- To compare the jejunal pouch technique with Roux-en-Y (ReY) reconstruction regarding postoperative morbidity, postprandial symptoms, and nutritional status.
Main Methods:
- A comparative study involving 45 patients undergoing curative total gastrectomy and esophagojejunostomy.
- Patients were divided into two groups: jejunal pouch construction (27 patients) and ReY reconstruction (18 patients), both using the EEA instrument.
- Outcomes assessed included postoperative morbidity, postprandial symptoms, and nutritional parameters (serum protein, albumin, body weight).
Main Results:
- A larger EEA (≥28 mm) was used in significantly more patients in the jejunal pouch group (25/27) compared to the ReY group (8/18).
- Anastomotic stricture occurred in only one patient in the pouch group versus four in the ReY group (p < 0.05).
- The jejunal pouch group experienced fewer postprandial symptoms, and stricture/symptom incidence was lower with larger EEA sizes (≥28 mm).
Conclusions:
- Jejunal pouch reconstruction enables the use of larger EEA instruments, effectively reducing the incidence of anastomotic stricture and postprandial symptoms after total gastrectomy.
- While beneficial for preventing strictures and symptoms, the jejunal pouch technique did not demonstrate significant advantages in improving nutritional status post-gastrectomy.
- The size of the EEA instrument is a critical factor in preventing anastomotic complications.