Functional jejunal interposition, a reconstruction procedure, promotes functional outcomes after total gastrectomy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Digestive System Surgery

Background:

• Functional jejunal interposition (FJI) is a reconstruction method after total gastrectomy for gastric cancer.
• It aims to maintain jejunal continuity and duodenal food passage.

Purpose of the Study:

• Evaluate the clinical efficacy of FJI versus Roux-en-Y reconstruction after total gastrectomy.
• Compare functional outcomes and investigate physiological mechanisms of FJI.

Main Methods:

• Retrospective study of 71 patients receiving FJI and 79 receiving Roux-en-Y.
• Nutritional status and complication incidence were assessed up to 12 months post-surgery.
• Beagle models evaluated intestinal transit rate, interstitial cells of Cajal (ICC), inflammation, and apoptosis.

Main Results:

• FJI patients experienced less body weight loss and improved nutritional markers (hemoglobin, total protein) compared to Roux-en-Y.
• FJI significantly reduced post-operative complications like reflux esophagitis and dumping syndrome.
• Beagles with FJI showed increased ICC, reduced apoptosis, and less inflammation, indicating better food storage and motility.

Conclusions:

• FJI promotes nutritional recovery and reduces post-operative complications in gastric cancer patients.
• Mechanisms include reduced intestinal inflammation, preserved ICC, and improved food reservoir function.
• FJI is a beneficial reconstruction technique after total gastrectomy.