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. 1995 Jul;222(1):27–35. doi: 10.1097/00000658-199507000-00005

Jejunal pouch reconstruction after total gastrectomy for cancer. A randomized controlled trial.

Y Nakane 1, S Okumura 1, K Akehira 1, S Okamura 1, T Boku 1, T Okusa 1, K Tanaka 1, K Hioki 1
PMCID: PMC1234751  PMID: 7618964

Abstract

OBJECTIVE: The authors determined the optimum reconstruction procedure after total gastrectomy in terms of the quality of life of the patients. SUMMARY BACKGROUND DATA: Gastric replacement with various enteric reservoirs has been used to improve the postprandial symptoms and nutrition of patients after total gastrectomy. However, the effect of each is uncertain because no prospective randomized studies have been conducted. METHODS: A randomized controlled trial was conducted to compare the usefulness of the three reconstruction procedures of simple Roux-en-Y (RY; N = 10), pouch and Roux-en-Y (PR; N = 10), and pouch and interposition (PI; N = 10). In each subject, the postprandial symptoms, food intake in a single meal, body weight, serum nutritional parameters, and emptying time of the gastric substitute were evaluated. RESULTS: The PR group showed significantly greater food intake in a single meal than the RY and PI groups, and greater weight recovery than the PI group. A gastric emptying test also revealed satisfactory retention capacity and emptying time of the gastric substitute in the PR group. CONCLUSIONS: Pouch and Roux-en-Y reconstruction is the most useful of the three procedures for improving the postoperative quality of life. In patients with pouch and interposition reconstruction, the clinical assessment was quite poor, even though it is a physiologic route.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barone R. M. Reconstruction after total gastrectomy: construction of a Hunt-Lawrence pouch using Auto Suture staples. Am J Surg. 1979 May;137(5):578–584. doi: 10.1016/0002-9610(79)90027-8. [DOI] [PubMed] [Google Scholar]
  2. Bradley E. L., 3rd, Isaacs J., Hersh T., Davidson E. D., Millikan W. Nutritional consequences of total gastrectomy. Ann Surg. 1975 Oct;182(4):415–429. doi: 10.1097/00000658-197510000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Braga M., Zuliani W., Foppa L., Di Carlo V., Cristallo M. Food intake and nutritional status after total gastrectomy: results of a nutritional follow-up. Br J Surg. 1988 May;75(5):477–480. [PubMed] [Google Scholar]
  4. Brophy C. M., Moore J. G., Christian P. E., Egger M. J., Taylor A. T. Variability of gastric emptying measurements in man employing standardized radiolabeled meals. Dig Dis Sci. 1986 Aug;31(8):799–806. doi: 10.1007/BF01296046. [DOI] [PubMed] [Google Scholar]
  5. Buzby G. P., Mullen J. L., Matthews D. C., Hobbs C. L., Rosato E. F. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980 Jan;139(1):160–167. doi: 10.1016/0002-9610(80)90246-9. [DOI] [PubMed] [Google Scholar]
  6. Cuschieri A. Jejunal pouch reconstruction after total gastrectomy for cancer: experience in 29 patients. Br J Surg. 1990 Apr;77(4):421–424. doi: 10.1002/bjs.1800770421. [DOI] [PubMed] [Google Scholar]
  7. Elashoff J. D., Reedy T. J., Meyer J. H. Analysis of gastric emptying data. Gastroenterology. 1982 Dec;83(6):1306–1312. [PubMed] [Google Scholar]
  8. GERWIG W. H., Jr Transverse colon substitute pouch following total gastrectomy. A five year re-evaluation study. Am J Surg. 1962 Jan;103:15–17. doi: 10.1016/0002-9610(62)90005-3. [DOI] [PubMed] [Google Scholar]
  9. HAYS R. P., CLARK D. A. Nutrition in patients with total gastrectomy and a jejunal food pouch. Ann Surg. 1960 Nov;152:864–870. doi: 10.1097/00000658-196011000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. HUNT C. J. Construction of food pouch from segment of jejunum as substitute for stomach in total gastrectomy. AMA Arch Surg. 1952 May;64(5):601–608. doi: 10.1001/archsurg.1952.01260010619009. [DOI] [PubMed] [Google Scholar]
  11. Huguier M., Lancret J. M., Bernard P. F., Baschet C., Le Henand F. Functional results of different reconstructive procedures after total gastrectomy. Br J Surg. 1976 Sep;63(9):704–708. doi: 10.1002/bjs.1800630909. [DOI] [PubMed] [Google Scholar]
  12. LEE C. M., Jr Transposition of a colon segment as a gastric reservoir after total gastrectomy. Surg Gynecol Obstet. 1951 Apr;92(4):456–465. [PubMed] [Google Scholar]
  13. LONGMIRE W. P., Jr, BEAL J. M. Construction of a substitute gastric reservoir following total gastrectomy. Ann Surg. 1952 May;135(5):637–645. doi: 10.1097/00000658-195205000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Lygidakis N. J. Total gastrectomy for gastric carcinoma: a retrospective study of different procedures and assessment of a new technique of gastric reconstruction. Br J Surg. 1981 Sep;68(9):649–655. doi: 10.1002/bjs.1800680913. [DOI] [PubMed] [Google Scholar]
  15. Miholic J., Meyer H. J., Müller M. J., Weimann A., Pichlmayr R. Nutritional consequences of total gastrectomy: the relationship between mode of reconstruction, postprandial symptoms, and body composition. Surgery. 1990 Sep;108(3):488–494. [PubMed] [Google Scholar]
  16. Olbe L., Lundell L. Intestinal function after total gastrectomy and possible consequences of gastric replacement. World J Surg. 1987 Dec;11(6):713–719. doi: 10.1007/BF01656593. [DOI] [PubMed] [Google Scholar]
  17. Olbe L., Lundell L. Intestinal function after total gastrectomy and possible consequences of gastric replacement. World J Surg. 1987 Dec;11(6):713–719. doi: 10.1007/BF01656593. [DOI] [PubMed] [Google Scholar]
  18. Onodera T., Goseki N., Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984 Sep;85(9):1001–1005. [PubMed] [Google Scholar]
  19. Scott H. W., Jr, Law D. H., 4th, Gobbel W. G., Jr, Sawyers J. L. Clincal and metabolic studies after total gastrectomy with a Hunt-Lawrence jejunal food pouch. Am J Surg. 1968 Feb;115(2):148–156. doi: 10.1016/0002-9610(68)90022-6. [DOI] [PubMed] [Google Scholar]
  20. Thiede A., Fuchs K. H., Hamelman H. Pouch and Roux-en-Y reconstruction after gastrectomy. Arch Surg. 1987 Jul;122(7):837–842. doi: 10.1001/archsurg.1987.01400190103024. [DOI] [PubMed] [Google Scholar]
  21. Troidl H., Kusche J., Vestweber K. H., Eypasch E., Maul U. Pouch versus esophagojejunostomy after total gastrectomy: a randomized clinical trial. World J Surg. 1987 Dec;11(6):699–712. doi: 10.1007/BF01656592. [DOI] [PubMed] [Google Scholar]

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