Antireflux contrivance in jejunal pouch reconstruction after total and proximal gastrectomies

In the reconstruction after gastrectomy, a jejunal pouch may be inferior as a gastric substitute to an isoperistaltic jejunum in terms of preventing reflux. We have developed an antireflux contrivance.

A jejunal pouch was made by side-to-side anastomosis of both limbs of the jejunum folded into an inverted U, leaving a bridge of the jejunum 15 cm long at the top of the jejunal pouch (apical bridge). The apical bridge is cut near its oral end, and esophagojejunostomy is done, leaving the isoperistaltic jejunum 6-8 cm long positioned between esophagus and jejunal pouch.

This antireflux contrivance was performed in 37 patients undergoing total gastrectomy and in 22 patients undergoing proximal gastrectomy. There were no operative deaths in this series. Neither anastomotic bleeding nor anastomotic leakage were observed. In a questionnaire survey, 5 patients answered that they had had heartburn twice a week or more often, but the answer was not repeated by any patient. On endoscopic examination, all patients but 1 had normal findings for the esophagus. Mild esophagitis was observed in 1 patient.

The antireflux contrivance reported here can be easily, safely, and uniformly done, and it is a useful technique.