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

We report here for the first time a case of laparoscopic completion gastrectomy for pouch dysfunction after proximal gastrectomy. The patient was a man in his 60s. Ten years ago, he underwent a proximal gastrectomy and jejunal pouch interposition for gastric cancer. Although there had been no recurrence, a health check revealed malnutrition, and he was referred to our hospital with a diagnosis of ileus due to jejunal pouch dysfunction. He had a functional obstruction due to the dilation of the jejunal pouch and food retention and also had reflux esophagitis(LA classification:Gr D). As he had severe nutritional disorders(BMI 13.2, ALB 2.1 g/dL), he underwent laparoscopic enterostomy, and nutritional therapy for approximately 6 months. After which, he underwent laparoscopic completion gastrectomy and jejunal pouch resection. A Roux-en- Y reconstruction was performed, and a jejuno-jejunal anastomosis was performed by preserving part of the interposed jejunum. He was discharged on the 13th day after surgery with oral intake. Five years after surgery, the patient's BMI had increased to 19.7, and reflux esophagitis had improved to Gr M. In patients expected to survive long-term after gastrectomy, the occurrence of jejunal pouch dysfunction must be considered.