[Pedicle transplantation of a transverse colon segment after total gastrectomy]

This report is concerned with series of patients with advanced gastric cancer in whom transverse colon segment interposition, namely an end-to-end esophagocolostomy plus coloduodenostomy (Type-I) from 1965 to 1970 and an end-to-side esophagocolostomy plus coloduodenostomy (Type-II) from 1986 to 1996 were performed after total gastrectomy. Fifty-two patients with Type-I reconstruction and 133 patients with Type-II reconstruction after total gastrectomy were studied. Postoperative nutritional condition and complications were investigated and changes in the size and high amplitude propagated contractions of the interposed colon were measured.

The interposed transverse colon segment which was placed in an iso-peristaltic fashion between esophagus and duodenum dilated gradually and capable of taking a reasonable quantity of food at one time. The nutritional status was good especially in long-term survivors. Complications such as reflux esophagitis (12.0% after Type-I and zero% in Type-II fashion) have occurred. The iodinated Triolein 131I absorption test has shown 92.4% absorption rate of the material, a value comparable to that of patients subjected to Billroth-I type gastric resection. In conclusion, pedicle transplantation of a segment of the transverse colon, especially Type-II fashion, is feasible and useful to use in patients undergoing total gastrectomy.