An original method for isoantiperistaltic jejunogastroplastic operation without intestinal inserts in distal subtotal...

A novel method for subtotal gastric resection is described with the construction of an isoantiperistaltic artificial stomach formed from the small intestine and the duodenum at Treitz's ligament without any intestinal inserts, Brown's and Roux's anastomoses, and with an invaginated anastomosis between the stomach and the reservoir measuring 1.5-2 cm in length. Fifty-nine operations were performed. No incoherent sutures were observed in the gastric-reservoir anastomosis. In 1 patient, due to a technical fault, duodenal necrosis with fatal outcome was encountered. Two patients developed pancreatic necrosis of the horizontal part of the duodenum. The general condition of all of the followed-up patients is good. They had a weight gain ranging from 2 to 15 kg. When a broad anastomosis (exceeding 3 cm) was constructed, in 6 patients examined by endoscopy done in a horizontal position, small volumes of bile reflux into the gastric stub were found. In gastric resections performed according to Billroth II, a refluent gastritis was observed in 62.3% of the patients.