Clinical Evaluation of the Jejunal Pouch-Roux-Y Reconstruction after Total Gastrectomy

Takashi Ichikura, Toshiya Ogawa, Kentaro Chochi, Takashi Majima, Kazuhiko Uefuji and Hidetaka Mochizuki

Department of Surgery I, National Defense Medical College

The purpose of this study was to evaluate the clinical significance of reconstruction using a jejunal pouch after total gastrectomy. Among the patients who underwent total gastrectomy with a curability of A or B from 1994 to 1998, 33 patients with jejunal pouch-Roux-Y reconstruction (pouch-Roux-Y group) and 39 patients with ρ-Roux-Y reconstruction (ρ-Roux-Y group) were enrolled in this study. No difference existed in the incidence of postoperative mortality and morbidity between the two groups. There were no complications related to the jejunal pouch construction. Median duration of the operation was 310 minutes for the pouch-Roux-Y group and 290 minutes for the ρ-Roux-Y group. A questionnaire survey concerning postoperative physical condition revealed that the intake volume of each meal compared with the preoperative state was significantly larger in the pouch-Roux-Y group than in the ρ-Roux-Y group (p=0.01). A lower incidence of esophageal reflux of duodenal contents was observed in the pouch-Roux-Y group than in the ρ-Roux-Y group (p=0.03). There was a tendency toward a lower incidence of dumping syndrome in the pouch-Roux-Y group than in the ρ-Roux-Y group. Radiological studies using pound cake permeated with barium or rice gruel mixed with SITZMARKS revealed slower emptying of the gastric contents in the pouch-Roux-Y group compared with the ρ-Roux-Y group. We concluded that jejunal pouch-Roux-Y reconstruction can be a standard procedure after total gastrectomy from the point of view of surgical ease and safety and postoperative physical condition.

Key words
jejunal pouch-Roux-Y reconstruction, total gastrectomy, postoperative physical condition

Reprint requests
Takashi Ichikura Department of Surgery I, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 JAPAN

Accepted
September 22, 1999

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