Skip to main content
Log in

Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan

  • Review Article
  • Published:
Surgery Today Aims and scope Submit manuscript


The Japanese Society for the Study of Postoperative Morbidity after Gastrectomy conducted a nationwide questionnaire survey to clarify the current status of reconstruction after gastrectomy. One hundred and forty-five institutions (66%) responded to the survey. The questionnaire dealt with the reconstruction after a distal gastrectomy, pylorus-preserving gastrectomy (PPG), total gastrectomy, and proximal gastrectomy. The most common method of reconstruction after distal gastrectomy was Billroth I in 112 institutions (74%), and Roux-en-Y (RY) in 30 (21%). Seventy-seven institutions (53%) responded to the PPG questions. The lengths of the antral cuff were widely distributed among the institutions. Segmental gastrectomy was performed by 23 institutions for limited cases. The most common method of reconstruction after total gastrectomy was RY in 138 institutions (95%). Reconstruction with a pouch after total gastrectomy was done in 26 institutions (18%). The most common reconstructions after proximal gastrectomy were esophagogastrostomy in 69 institutions (48%), jejunal interposition in 41 (28%), double tract in 19 (13%) and pouch reconstruction in 6 (7%). Although most Japanese surgeons are concerned about the revised methods of reconstruction and quality of life after gastrectomy, surgeons have not yet reached a full consensus on these issues.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. Schlatter C. Uber Ernahrung und Verdauung nach vollstandiger Entfernung des Magens und Oesophagojejunostomie bein Menschen. Brun`s Beitruge Klin Chir. 1897;19:757–75.

    Google Scholar 

  2. Osugi H, Fukuhara K, Takada N, Takemura M, Kinoshita H. Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology. 2004;51:1215–8.

    PubMed  CAS  Google Scholar 

  3. Shinoto K, Ochiai T, Suzuki T, Okazumi S, Ozaki M. Effectiveness of Roux-en Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics. Surg Today. 2003;33:169–77.

    Article  PubMed  Google Scholar 

  4. Nunobe S, Sasako M, Saka M, Fukagawa T, Katai H, Sano T, et al. Billroth I versus Roux-en Y reconstructions: a quality of life survey at 5 years. Int J Clin Oncol. 2007;12:433–9.

    Article  PubMed  Google Scholar 

  5. Ishikawa M, Kitayama J, Kaizaki S, Nakayama H, Ishigami H, Nagawa H, et al. Prospective randomized trial comparing Billroth I and Roux-en Y procedures after distal gastrectomy for gastric carcinoma. World J Surg. 2005;29:1415–20.

    Article  PubMed  Google Scholar 

  6. Maki T, Shiratori T, Sugawara K, Hatafuku T. Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery. 1967;61:838–45.

    PubMed  CAS  Google Scholar 

  7. Kodama M, Koyama K. Indications for pylorus-preserving gastrectomy for early gastric cancer located in the middle third of the stomach. World J Surg. 1991;15:628–33.

    Article  PubMed  CAS  Google Scholar 

  8. Imada T, Rino Y, Takahashi M, Suzuki M, Tanaka J, Amano T, et al. Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy. Surgery. 1998;123:165–70.

    Article  PubMed  CAS  Google Scholar 

  9. Park J, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg. 2008;32:1029–36.

    Article  Google Scholar 

  10. Nishikawa K, Kawahara H, Yumiba T, Nishida T, Inoue Y, Ito T, et al. Functional characteristics of the pylorus in patients undergoing pylorus-preserving gastrectomy for early gastric cancer. Surgery. 2002;131:613–24.

    Article  PubMed  Google Scholar 

  11. Nakane Y, Michiura T, Inoue K, Sato M, Nakai K, Yamamichi K. Length of the antral segment in pylorus-preserving gastrectomy. Br J Surg. 2002;89:220–4.

    PubMed  CAS  Google Scholar 

  12. Nunobe S, Hiki N, Fukunaga T, Tokunaga M, Ohyama S, Seto S, et al. Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis. World J Surg. 2007;31:2335–40.

    Article  PubMed  Google Scholar 

  13. Morita S, Sasako M, Saka M, Fukagawa T, Sano T, Katai H. Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy. Gastric Cancer. 2010;13:109–16.

    Article  PubMed  Google Scholar 

  14. Fujimura T, Fushida S, Kayahara M, Ohta T, Kinami S, Miwa K. Transectional gastrectomy: an old but renewed concept for early gastric cancer. Surg Today. 2010;40:398–403.

    Article  PubMed  Google Scholar 

  15. Lehnert T, Buhl K. Techniques of reconstruction after total gastrectomy for cancer. Br J Surg. 2004;91:528–39.

    Article  PubMed  CAS  Google Scholar 

  16. Piessen G, Triboulet JP, Mariette C. Reconstruction after gastrectomy: which technique is best? J Visc Surg. 2010;147:273–83.

    Article  Google Scholar 

  17. Nozoe T, Anai H, Sugimachi K. Usefulness of reconstruction with jejunal pouch in total gastrectomy for gastric cancer in early improvement of nutritional condition. Am J Surg. 2001;181:274–8.

    Article  PubMed  CAS  Google Scholar 

  18. Miyoshi K, Fuchimoto S, Ohsaki T, Sakata T, Ohtsuka S, Takakura N. Long-term effects of jejunal pouch added to Roux-en Y reconstruction after total gastrectomy. Gastric Cancer. 2001;4:156–61.

    Article  PubMed  CAS  Google Scholar 

  19. Adachi S, Inagawa S, Enomoto T, Shinozaki E, Oda T, Kawamoto T. Subjective and functional results after total gastrectomy: prospective study for long-term comparison of reconstruction procedure. Gastric Cancer. 2003;6:24–9.

    Article  PubMed  Google Scholar 

  20. Takeshita K, Sekita Y, Tani M. Median- and long-term results of jejunal pouch reconstruction after a total and proximal gastrectomy. Surg Today. 2007;37:754–61.

    Article  PubMed  Google Scholar 

  21. Shibata C, Ueno T, Kakyou M, Kinouchi M, Sasaki I. Results of reconstruction with jejunal pouch after gastrectomy: correlation with gastrointestinal motor activity. Dig Surg. 2009;26:177–86.

    Article  PubMed  Google Scholar 

  22. Nanthakumaran S, Suttie S, Chandler HW, Park GM. Optimal gastric pouch reconstruction post-gastrectomy. Gastric Cancer. 2008;11:33–6.

    Article  PubMed  Google Scholar 

  23. Tono C, Tarashima M, Takagane A, Abe K. Ideal reconstruction after total gastrectomy by interposition of jejunal pouch considered by emptying time. World J Surg. 2003;27:1113–8.

    Article  PubMed  Google Scholar 

  24. Tanaka T, Kusunoki M, Fujiwara Y, Nakagawa K, Utsunomiya J. Jejunal pouch length influences metabolism after total gastrectomy. Hepatogastroenterology. 1997;44:891–6.

    PubMed  CAS  Google Scholar 

  25. Kalmar K, Kaposztas Z, Varga G, Cseke L, Papp A, Horvath OP. Comparing aboral versus oral pouch with preserved duodenal passage after total gastrectomy: does the position of the gastric substitute reservoir count? Gastric Cancer. 2008;11:72–80.

    Article  PubMed  Google Scholar 

  26. Kobayashi M, Araki K, Okamoto T, Okabayashi T, Akimori T, Sugimoto T. Anti-reflux pouch-esophagostomy after proximal gastrectomy with jejunal pouch interposition reconstruction. Hepatogastroenterology. 2007;54:116–8.

    PubMed  Google Scholar 

  27. Yoo CH, Sohn BH, Han WK, Pae WK. Proximal gastrectomy reconstructed by jejunal pouch interposition for upper third gastric cancer: prospective randomized study. World J Surg. 2005;29:1592–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations



Corresponding author

Correspondence to Kazuhide Kumagai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kumagai, K., Shimizu, K., Yokoyama, N. et al. Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan. Surg Today 42, 411–418 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: