[Gastric pouch with preserved duodenal passage: attempt to optimize reconstruction after total gastrectomy]

A new method--aboral pouch with preserved duodenal passage--has been introduced for reconstruction after total gastrectomy. After excising the stomach, preparation of the Roux loop and construction of an end-to-side esophago-jejunostomy, the Roux loop is anastomosed to the duodenal stump side-to-end approximately 40-50 cm distal from the esophago-jejunostomy. Right beneath this second anastomosis the Roux limb is closed with a stapler to provide unidirectional passage through the duodenum. An aboral pouch is constructed by a 15 cm long side-to-side anastomosis between the Roux limb under the stapled segment and the aboral end of the Y limb. The advantages of both the reservoir constructing and the interposition methods (duodenal passage preserved) are combined with this new form of reconstruction. The additional benefit is that the reservoir is constructed in aboral position, as previously suggested by the authors.