[A Case of Laparoscopic Completion Gastrectomy for Pouch Dysfunction after Proximal Gastrectomy].

Area of Science:

• Gastroenterology
• Surgical Oncology
• Digestive Surgery

Background:

• Proximal gastrectomy with jejunal pouch interposition is a surgical option for gastric cancer.
• Jejunal pouch dysfunction can lead to severe complications like malnutrition and reflux esophagitis.
• Long-term survivors of gastrectomy require monitoring for delayed complications.

Purpose of the Study:

• To report the first case of laparoscopic completion gastrectomy for jejunal pouch dysfunction.
• To describe the management of severe malnutrition and reflux esophagitis secondary to pouch dysfunction.
• To highlight the importance of considering jejunal pouch dysfunction in long-term gastrectomy survivors.

Main Methods:

• A laparoscopic completion gastrectomy and jejunal pouch resection were performed.
• Roux-en-Y reconstruction with jejuno-jejunal anastomosis was utilized.
• Preoperative nutritional support via laparoscopic enterostomy was administered for 6 months.

Main Results:

• The patient experienced significant improvement in nutritional status (BMI increased from 13.2 to 19.7).
• Reflux esophagitis (LA grade D) improved to grade M post-surgery.
• The patient was discharged with oral intake and showed sustained recovery at 5-year follow-up.

Conclusions:

• Laparoscopic completion gastrectomy is a viable option for managing severe jejunal pouch dysfunction.
• Early recognition and intervention are crucial for improving outcomes in patients with post-gastrectomy complications.
• Jejunal pouch dysfunction should be considered in the long-term management of gastric cancer survivors.