Abstract
Purpose
Many reconstruction methods after total gastrectomy (TG) lead patients to dumping syndrome, reflux esophagitis, and poor postoperative quality of life (QOL). To improve patients’ postoperative QOL after TG, we introduce a new reconstruction method named “pouch-double tract” (PDT).
Methods
A prospective randomized study was performed between 2005 and 2007 in 29 patients who were diagnosed as stage I or II gastric cancers preoperatively. Patients were followed until the end of 2009. Conventional Roux-en-Y reconstruction (RY) was performed in 15 patients, and PDT was used in 14 patients. Postoperative patients’ nutritional assessments and patients’ QOL were compared between the groups.
Results
PDT did not increase morbidity or mortality compared with RY. Patients in the PDT group did not complain of dumping and showed better postoperative food intake. Body weight recovered better in PDT than in RY.
Conclusion
PDT is safe and associated with better nutritional status compared with the RY.
Similar content being viewed by others
References
Espat NJ, Karpeh M (1998) Reconstruction following total gastrectomy: a review and summary of the randomized prospective clinical trials. Surg Oncol 7:65–69
Matei D, Dadu R, Prundus R, Danci I, Ciobanu L, Mocan T, Bocsan C, Zaharie R, Serban A, Tantau M, Iancu C, Alexandru I, Al-Hajjar N, Andreica V (2010) Alkaline reflux esophagitis in patients with total gastrectomy and Roux en Y esojejunostomy. J Gastrointestin Liver Dis 19:247–252
Lehnert T, Buhl K (2004) Techniques of reconstruction after total gastrectomy for cancer. Br J Surg 91:528–539
Horvath OP, Kalmar K, Cseke L, Poto L, Zambo K (2001) Nutritional and life-quality consequences of aboral pouch construction after total gastrectomy: a randomized, controlled study. Eur J Surg Oncol 27:558–563
Nozoe T, Anai H, Sugimachi K (2001) Usefulness of reconstruction with jejunal pouch in total gastrectomy for gastric cancer in early improvement of nutritional condition. Am J Surg 181:274–278
Kono K, Iizuka H, Sekikawa T, Sugai H, Takahashi A, Fujii H, Matsumoto Y (2003) Improved quality of life with jejunal pouch reconstruction after total gastrectomy. Am J Surg 185:150–154
Yumiba T, Kawahara H, Nishikawa K, Nishida T, Inoue Y, Ito T, Matsuda H (2005) Jejunal pouch interposition with fundic-like plication after total gastrectomy. Surg Today 35:623–628
Iwahashi M, Nakamori M, Nakamura M, Naka T, Ojima T, Iida T, Katsuda M, Ueda K, Yamaue H (2009) Evaluation of double tract reconstruction after total gastrectomy in patients with gastric cancer: prospective randomized controlled trial. World J Surg 33:1882–1888
Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma. 2nd English edn. Gastric Cancer 1:10–24
Baccaro F, Moreno JB, Borlenghi C, Aquino L, Armesto G, Plaza G, Zapata S (2007) Subjective global assessment in the clinical setting. J Parenter Enteral Nutr 31:406–409
Ikeguchi M, Kuroda H, Kihara K, Hatata T, Matsunaga T, Fukuda K, Saito H, Tatebe S (2010) Nutritional assessment of patients after pylorus-preserving gastrectomy for early gastric cancer. Indian J Surg 72:453–457
Takeshita K, Sekita Y, Tani M (2007) Medium- and long-term results of jejunal pouch reconstruction after a total and proximal gastrectomy. Surg Today 37:754–761
Fein M, Fuchs KH, Thalheimer A, Freys SM, Heimbucher J, Thiede A (2008) Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial. Ann Surg 247:759–765
Gertler R, Rosenberg R, Feith M, Schuster T, Friess H (2009) Pouch vs. no pouch following total gastrectomy: meta-analysis and systematic review. Am J Gastroenterol 104:2838–2851
Tono C, Terashima M, Takagane A, Abe K (2003) Ideal reconstruction after total gastrectomy by the interposition of a jejunal pouch considered by emptying time. World J Surg 27:1113–1118
Tanaka T, Kusunoki M, Fujiwara Y, Nakagawa K, Utsunomiya J (1997) Jejunal pouch length influences metabolism after total gastrectomy. Hepatogastroenterol 44:891–896
Adachi S, Inagawa S, Enomoto T, Shinozaki E, Oda T, Kawamoto T (2003) Subjective and functional results after total gastrectomy: prospective study for longterm comparison of reconstruction procedures. Gastric Cancer 6:24–29
Schwarz A, Büchler M, Usinger K, Rieger H, Glasbrenner B, Friess H, Kunz R, Beger HG (1996) Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the ulm pouch: prospective randomized clinical study. World J Surg 20:60–67
Mochiki E, Kamiyama Y, Aihara R, Nakabayashi T, Kamimura H, Asao T, Kuwano H (2004) Postoperative functional evaluation of jejunal interposition with or without a pouch after a total gastrectomy for gastric cancer. Am J Surg 187:728–735
Takase M, Sumiyama Y, Nagao J (2003) Quantitative evaluation of reconstruction methods after gastrectomy using a new type of examination: digestion and absorption test with stable isotope 13C-labeled lipid compound. Gastric Cancer 6:134–141
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ikeguchi, M., Kuroda, H., Saito, H. et al. A new pouch reconstruction method after total gastrectomy (pouch-double tract method) improved the postoperative quality of life of patients with gastric cancer. Langenbecks Arch Surg 396, 777–781 (2011). https://doi.org/10.1007/s00423-011-0779-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-011-0779-6