Total gastrectomy for gastric cancer: the rationale for J-pouch reservoir

This prospective study examines the results of total gastrectomy in 56 consecutive patients (38 males and 18 females) and compares Hunt-Limo-Basto J-pouch reconstruction (23 patients) with simple oesophago-jejunostomy (33 patients). There was no difference in morbidity and mortality between the two groups, which are fairly well-matched proportionately in age, concomitant disease and stage of disease. There was, however, a male predominance in the non-pouch group. Anastomotic leak occurred in only one patient with gastric reconstruction while one duodenal stump leak developed in the non-pouch patient. Construction of the stapled J-pouch extended the operation by a mean time of 14 min. The only advantage of the J-pouch is that it facilitates introduction of a larger diameter stapler for oesophago-jejunostomy. The nutritional benefit remains uncertain.