Jejunal pouch reconstruction after total gastrectomy for cancer: experience in 29 patients

The experience with interposed jejunal pouch after total gastrectomy for cancer in 29 patients is reviewed. There were two postoperative deaths (7 per cent) due, respectively, to myocardial infarction on day 5 and massive haemorrhage from the splenic vein on day 14. Anastomotic leaks, all from the proximal anastomosis, were encountered in three patients (11 per cent). These consisted of one minor clinical leak in a stapled anastomosis and two radiological leaks from hand-sutured anastomoses. Obstruction of the pouch or its conduit by recurrent tumour was not observed in any patient, including those who died from metastatic disease. There was one instance of benign stenosis of the distal anastomosis to the duodenum which required revisional surgery. The symptomatic assessment in the long-term surviving patients was good except for mild oesophagitis due to bile reflux in five patients. Body-weight was maintained and adverse nutritional consequences were not observed.