Ileocecal interpositional graft for gastric replacement after total gastrectomy

Area of Science:

• Surgical Oncology
• Gastroenterology
• Medical Devices

Background:

• Total gastrectomy is a common treatment for gastric cancer.
• Reconstruction after total gastrectomy aims to restore digestive function and minimize complications.
• Traditional reconstruction methods can lead to issues like reflux and dumping syndrome.

Purpose of the Study:

• To evaluate the efficacy and safety of ileocecal segment interpositional grafts following total gastrectomy for gastric cancer.
• To assess the advantages and disadvantages of this specific reconstruction technique.
• To compare subdiaphragmatic and intrathoracic reconstruction approaches.

Main Methods:

• A prospective study involving 24 gastric carcinoma patients undergoing total gastrectomy.
• Ileocecal interpositional graft reconstruction was performed (19 subdiaphragmatic, 5 intrathoracic).
• Patients were followed for at least 12 months, assessing morbidity, weight changes, and gastrointestinal symptoms. Diagnostic imaging and pouch emptying studies were conducted.

Main Results:

• Perioperative mortality was 8.3%.
• No significant reflux esophagitis or dumping symptoms were reported in the subdiaphragmatic group; mild reflux occurred in one intrathoracic case.
• The graft functioned well as a food reservoir, with an average postoperative body weight loss under 10%.

Conclusions:

• Ileocecal interposition grafts provide effective functional stomach replacement after total gastrectomy.
• The technique successfully prevents reflux esophagitis and maintains reservoir capacity.
• This method offers a simpler alternative to other pouch reconstructions with acceptable morbidity and mortality.