Total Gastrectomy with Conventional Lymphadenectomy

Abstract

In 1884 Connor attempted the first total gastrectomy in humans, reestablishing continuity with an esophagoduodenostomy. His patient did not survive the operation. In 1897 Schlatter carried out the first successful total gastrectomy. In 1892, Roux described a new procedure where the jejunal loop was divided and the distal limb was joined to the esophagus. The proximal limb of the loop was anastomosed to the jejunum some 45 cm distal to the esophagus. A large number of gastric substitutes have been tried over the past century, grouped into large and small bowel procedures. Some operations preserve the continuity through the duodenum. Others bypass the duodenal passage. Some procedures include a pouch construction and/or an antireflux modification. Currently, Roux-en-Y reconstruction is still the most widely used procedure after a total gastrectomy.