Pathophysiological Assessments in Patients with Pylorus-Preserving Distal Gastrectomy Reconstructed by Jejunal J Pouch Interposition and Vagal Nerve Preservation

Ryouichi Tomita¹⁾²⁾, Shigeru Fujisaki²⁾ and Katsuhisa Tanjoh²⁾

¹⁾Department of Surgery, Nippon Dental University School of Dentistry at Tokyo
²⁾First Department of Surgery, Nihon University School of Medicine

Purpose: To clarify the significance of pylorus in patients after vagal nerve preserving distal gastrectomy with jejunal J pouch interposition, we studied gastric emptying and postoperative quality of life in those with or without pylorus. Materials and methods: We studied emptying time of a semisolid diet (radioisotope method using ^99mTc-tin colloid-labeled rice gruel) and postoperative quality of life in 18 patients [group A: 12 men and 6 women 48-72 years old (average: 60.9 years) ] who underwent both vagal nerve and pylorus preserving distal gastrectomy with jejunal J pouch interposition (D1+α lymphadenectomy, curability A) and in 18 patients [group B: 10 men and 8 women 34-70 years old (average: 63.1 years) ] who underwent vagal nerve preserving distal gastrectomy with jejunal J pouch interposition (D1+α lymphadenectomy, curability A) for early gastric cancer. Controls were 18 vagal nerve and pylorus preserving distal gastrectom patients (D1+α lymphadenectomy, curability A) [group C; 12 men and 6 women 36-75 years old (average 56.7 years) ] for early gastric cancer. Results: Early dumping syndrome and reflux esophagitis were less detected in groups A and C than group B. A feeling of gastric fullness after meals was more significant in group B than in groups A and C (p=0.0012, P=0.0007, respectively). Microgastria was significantly detected in group C than groups A and B (p<0.0001, p=0.0023, respectively). The time to 50% residual rate was 65.3±8.7 minutes in group A, 80.5±16.2 minutes in group B, and 61.9±10.2 minutes in group C. Results showed more delayed emptying time in group B than in groups A and C (p=0.0005, p<0.0001, respectively). Residual rate in the jejunal J pouch after 120 minutes was 30.1±6.8% in group A, 37.9±5.6% in group B, and 24.5±8.9% in group C. The residual rate after 120 minutes was significantly higher in group B than in groups A and C (p=0.0020, p<0.0001, respectively). Conclusions: These results showed that pylorus preserving distal gastrectomy improved postoperative delayed emptying of a semisolid diet and prevented a feeling of gastric fullness after meals due to retention in the residual stomach.

Key words
function preserving operation, vagal nerve, lower esophagus sphincter, jejunal J pouch, pathophysiology

Reprint requests
Ryouichi Tomita Department of Surgery, Nippon Dental University School of Dentistry at Tokyo 6-12-16 Fujimi, Chiyoda-ku, Tokyo, 102-8158 JAPAN

Accepted
March 26, 2003

To read the PDF file you will need Abobe Reader installed on your computer.