Clinical results of various reconstructions employed after total gastrectomy

Halabi, Hatem M. El; Wt, Lawrence

doi:10.1002/jso.20928

Cited by 28 publications

(20 citation statements)

References 38 publications

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“…Comparison between JPI-T and JPRY-T also begs the question of whether the passage of ingested content through the duodenum is important to maximize patients’ QOL. Two review papers concluded that this ‘duodenal passage’ was not associated with improvement in postoperative QOL [46, 47]. …”

Section: Discussionmentioning

confidence: 99%

Results of Reconstruction with Jejunal Pouch after Gastrectomy: Correlation with Gastrointestinal Motor Activity

Shibata

Ueno²,

Kakyou³

et al. 2009

Dig Surg

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Background/Aims: To investigate if restoration of esophago-intestinal or esophago-gastric continuity with a jejunal pouch after total or proximal gastrectomy has clinical benefits. Methods: We reviewed all relevant reports published after 1990 that dealt with the clinical results of reconstruction with a jejunal pouch after total and proximal gastrectomies and correlated those findings with results for gastrointestinal motility. Reports were chosen from a search of the literature using PubMed. Results: After total gastrectomy, the benefit of a jejunal J pouch interposition was not apparent compared to simple jejunal interposition; indeed, one trial concluded that simple interposition was better than pouch interposition in terms of food intake. In contrast, results with a jejunal J pouch during Roux-en-Y (RY) type reconstruction were better than with conventional RY reconstruction in terms of food intake, nutritional status, body weight (BW) and symptoms. Advantages were also shown for a jejunal pouch with an inverted U shape interposed between the esophagus and residual stomach after proximal gastrectomy. Reconstruction using a jejunal pouch after proximal gastrectomy was better than esophagogastrostomy or simple jejunal interposition in terms of food intake, BW and symptoms. There were not enough data to conclude any benefits of a jejunal J pouch between the gastric remnant and the duodenum after distal gastrectomy. Conclusions: Clinical results of restoration of intestinal continuity with a jejunal pouch after total and proximal gastrectomies may be attributed, at least in part, to the relationship between the motor activity of the gastric remnant, duodenum and jejunal pouch.

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Section: Discussionmentioning

confidence: 99%

Results of Reconstruction with Jejunal Pouch after Gastrectomy: Correlation with Gastrointestinal Motor Activity

Shibata

Ueno²,

Kakyou³

et al. 2009

Dig Surg

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“…Are cited: dumping in about 2% to 8%, diarrhea and malabsorption in 3% to 10%. Recurrence of cancer at the esophagus-jejunal anastomosis, because inadequate surgical margins is reported to occur in 1% to 4% of cases 3,4,6,19,28,31 . The overall mortality of total gastrectomy for gastric cancer ranges from 2% to 15%, secondary to surgery, and up to 20% if included other complications not directly related to surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Other early complications such as abscesses, pneumonia, pulmonary embolism and thrombosis, and urinary tract infections are also present. In most cases, aggressive measures should be taken, such as treatment in the intensive care unit, drainage, relaparotomy, wide spectrum antibiotic therapy and nutritional support 3,8,13 . Recent randomized trials show no significant differences if the esophageal-jejunal anastomosis is manual or mechanical, since that the procedure is well made and indicated following well-established technical principles 13,26 .…”

Section: Introductionmentioning

confidence: 99%

Complicações pós-operatórias após gastrectomia total no câncer gástrico: análise de 300 doentes

Andreollo¹,

Lopes²,

Neto³

2011

ABCD, arq. bras. cir. dig.

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-Background -A total gastrectomy is considered a procedure with a high level of complexity, has high complication rates, both local and general, because patients are mostly with clinical conditions and nutritional compromised by disease. ). Conclusões -A gastrectomia total é um procedimento que requer experiência do cirurgião, de sua equipe, empregando técnica cirúrgica aprimorada para minimizar as complicações pós-operatórias. As complicações pós-operatórias requerem cuidados no controle das infecções, das vias aéreas e cuidados nutricionais, diminuindo a mortalidade, aumentando a sobrevida e contribuindo para a qualidade de vida do doente.

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“…Most of these procedures use the small intestines [6]. Those using the colon (ileocecal juncture) are briefly exposed in this update but have not been studied in humans by controlled studies and are potentially fraught with the risk of additional complications (fistula, microbial pullulation) [7].…”

Section: Introductionmentioning

confidence: 99%

Reconstruction after gastrectomy: Which technique is best?

Piessen

Triboulet

Mariette

2010

Journal of Visceral Surgery

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Several reconstruction techniques are possible after gastrectomy. The best reconstruction is one, that maintains satisfactory nutritional status and quality of life while keeping postoperative morbidity as low as possible. The aim of this study was to describe the different reconstruction techniques that can be proposed after distal and total gastrectomy, heeding to the French guidelines on the use of mechanical sutures in these indications. We then conducted a review of randomized trials dealing with reconstruction techniques after distal and total gastrectomy. After distal gastrectomy, Roux-en-Y reconstruction seems superior to Billroth I and Billroth II reconstructions in terms of functional outcomes and long-term endoscopic results and should be chosen in patients with benign disease or superficial tumors. Otherwise, Billroth II should be preferred over Billroth I reconstruction because of lower postoperative morbidity and better oncologic margins. After total gastrectomy, Roux-en-Y reconstruction remains the easiest solution, with satisfactory functional results. Addition of a pouch reservoir after Roux-en-Y reconstruction seems to improve short-term functional outcome after total gastrectomy with better potential for nutritional intake. In the long-term, quality of life seems better mainly in patients with small-resected tumors associated with a good prognosis.

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Clinical results of various reconstructions employed after total gastrectomy

Cited by 28 publications

References 38 publications

Results of Reconstruction with Jejunal Pouch after Gastrectomy: Correlation with Gastrointestinal Motor Activity

Results of Reconstruction with Jejunal Pouch after Gastrectomy: Correlation with Gastrointestinal Motor Activity

Complicações pós-operatórias após gastrectomia total no câncer gástrico: análise de 300 doentes

Reconstruction after gastrectomy: Which technique is best?

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