[Physiopathologic concepts related to patients undergoing total gastrectomy]

Total gastrectomy due, principally, to malignant diseases, has two aims: a) to carry out an adequate oncological operation, and b) to perform a simple reconstruction of the digestive tract which must avoid biliary esophageal reflux. All other functional disturbances may be controlled by adequate diet. Pseudogastric jejunal pouches are, at present, being abandoned. The reduced intestinal malabsorption--favored by the loss of the stomach and the bacterial proliferation--is kept under control, it seemed, by the function of the "ileal brake", which, when certain fat acids and other substances reach the ileum, produce hypomotility of the jejunum with slowing up of the intestinal flow. In such patients, an important catabolism prolongs for some weeks after the operation, and lose also weight due to poor appetite and not eating enough. In view of this, it is considered justified the application of an enterostomy tube during the operation, in order to provide a supplement of food by direct intestinal way, which should begin to be used only after the first postoperative days (five-six).