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Reconstruction after total gastrectomy by the interposition of a double jejunal pouch using a double stapling
1Second Department of Surgery, Toho University School of Medicine, Tokyo, Japan.
Background:
After total gastrectomy, sustaining good nutrition is extremely important for maintaining quality of life. A technique of neogastric pouch formation based on current physiological reconstructive principles is presented.
Methods:
The use of a modified interpositioned double jejunal pouch following total gastrectomy in 18 patients with cancer was reviewed. This technique results in a complete pouch and uses a double stapling technique with site-specific anastomosis between the oesophagus and pouch, in which a Hisoid angle is created.
Results:
There were no anastomotic leaks and pouch blood flow was within normal expected limits. Mean oesophageal pH above 7.0 for one 24-h period was 7.7 per cent. Emptying half-time was 67.8 min. After 2 years mean body-weight was 98.3 per cent of expected, mean food volume was 94.0 per cent of expected and mean meal frequency was 3.0 per day.
Conclusion:
This form of gastric reconstruction is an acceptable procedure which improves the quality of life in patients undergoing total gastrectomy.