Reservoir function after subtotal or total gastrectomy with or without gastric substitute

Area of Science:

• Gastroenterology
• Surgical Oncology
• Digestive System Physiology

Background:

• Gastrectomy for cancer necessitates reconstruction, impacting reservoir function.
• Different surgical techniques, including Roux-en-Y esophagojejunostomy and gastric substitutes, are employed.
• Understanding reservoir function is crucial for post-operative patient outcomes.

Purpose of the Study:

• To evaluate and compare the volume and pressure characteristics of gastric reservoir function in patients after different gastrectomy reconstructions.
• To assess the functional differences between straight Roux-en-Y esophagojejunostomy, s-shaped gastric substitute, and subtotal gastrectomy remnant.
• To determine if an s-shaped gastric substitute mimics the reservoir function of an intact stomach.

Main Methods:

• Study included three patient groups >1 year post-gastrectomy for cancer.
• Utilized a latex balloon filled with water to measure maximal volume capacity and basal pressure.
• Compared reservoir function in straight Roux-en-Y, s-shaped gastric substitute, and subtotal gastrectomy remnant groups.

Main Results:

• Subtotal gastrectomy remnant: 400 ml capacity at 13.9 cmH2O.
• S-shaped gastric substitute: 475 ml capacity at 10.4 cmH2O.
• Straight Roux-en-Y esophagojejunostomy: Significantly higher basal pressure (40.4 cmH2O) and pressure amplitudes, with lower capacity (180 ml).

Conclusions:

• An s-shaped gastric substitute demonstrates low-pressure reservoir characteristics, comparable to an intact stomach.
• Straight Roux-en-Y esophagojejunostomy results in a high-pressure, low-capacity proximal limb.
• Surgical reconstruction technique significantly influences post-gastrectomy reservoir function.