Ileocecal interpositional graft for gastric replacement after total gastrectomy

The aim of this study is to evaluate the technique of ileocecal segment interpositional graft after total gastrectomy for gastric cancer with assessment of its advantages and disadvantages.

This is a prospective study carried out at the National Cancer Institute, Cairo University. Twenty four patients with gastric carcinoma were identified from December 1998 to February 2003. All of them were submitted to surgery after preoperative clinical, radiological and endoscopic diagnosis. Total gastrectomy with ileocecal interpositional graft were done (19 subdiaphragmatic reconstruction and 5 intrathoracic reconstruction). Patients were followed up for at least 12 months for postoperative morbidity, body weight, reflux and dumping symptoms. Gastrografin swallow, barium swallow, upper GIT endoscopy were routinely done in all patients and pouch emptying time by Tc-99m sulpher colloid was done in 11 patients only.

Perioperative mortality was 8.3% (2/24). No patient reported reflux symptoms or showed endoscopic findings of reflux esophagitis in the subdiaphragmatic reconstruction group and mild reflux was noted in only one patient in the intrathoracic reconstruction group. No patient reported dumping symptoms. Emptying time showed good capacity as a reservoir of food. Postoperative decrease in body weight averaged less than 10% of preoperative weight.

Ileocecal interposition graft after total gastrectomy has the advantages of preventing reflux esophagitis and providing functional replacement of the stomach as a reservoir for ingested food. It can be done with acceptable morbidity and mortality. It is simpler than some of the pouch reconstructions and deserves more attention.