Comparing aboral versus oral pouch with preserved duodenal passage after total gastrectomy: does the position of the gastric substitute reservoir count?

Abstract

ing the duodenum, and respond properly to the changing levels of gastrointestinal hormones and neural information. The science of surgery is nowhere near reaching this ideal. With the gold standard Roux-en-Y reconstruction so far achieved, gastrectomized patients do not suffer from alkaline esophagitis. Different pouch construction methods and reconstructions of the duodenal passage are being trialled to improve functional results.In our previous studies, a Roux-en-Y-based but distally reconstructed pouch-the aboral pouch-was compared to Roux-en-Y reconstruction, as well as being compared to reconstruction with an aboral pouch and duodenal passage preservation [1][2][3][4]. Absorption studies supported pouch construction; gastrointestinal hormone studies suggested the superiority of duodenal passage preservation [4]. In this study, the site of the pouch is examined; two different reconstruction types, the traditional oral pouch and the aboral pouch, are compared. Based on our gastrointestinal hormonal studies, we believe in the superiority of duodenal passage preservation, that is why both pouch reconstructions were performed with duodenal passage preservation. Patients and methods Eligibility criteria and randomizationAll patients with a disease necessitating total gastrectomy were investigated for eligibility to enter the trial. Patients younger than 80 years, who had no historical data of previous bowel resection and in whom kidney and liver function tests had shown normal results, and in whom R0 resection could be performed, were considered eligible. During the operation, after evaluation of the feasibility of both reconstruction methods and clearance for technical resectability, randomization was performed via the envelope selection method. AbstractBackground. Total gastrectomy results in a signifi cant weight loss, different postgastrectomy symptoms, and a reduction in quality of life. Elaborate surgical reconstruction methods are evaluated to improve results. The present study compares two types of reconstructions-an aboral pouch with preserved duodenal passage and an oral pouch with preserved duodenal passage-differing only in the site of the pouch. Methods. Twenty-eight patients entered the study. Primary outcome measures-body weight, body mass index, and quality of life, and secondary outcome measures-serum nutritional parameters, scintigraphic small-intestinal passage, and lipid and carbohydrate absorption were measured 6, 12, and 24 months after surgery. Results. No signifi cant differences were found in anthropometric parameters or in quality of life between the groups. Regarding the secondary outcome measures, albumin levels were higher in the oral pouch group, while protein and immunoglobulin-A levels were higher in the aboral pouch group. Conclusion. The site of the reservoir does not signifi cantly infl uence the outcome after total gastrectomy and reconstruction with a preserved duodenal passage.

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

“…Other studies have suggested that the smaller pouches (5 and 10 cm) result in little benefit [22]. Concerning the site of the pouch after total gastrectomy, it did not significantly affect the QOL or outcome [25]. As the questionnaire survey for pouch reconstruction showed, the distribution of the pouch length varied widely, and the site of the pouch was generally constructed on the oral side.…”

Impact of reconstructive procedures with and without preserving the duodenal passage on body weight in patients after total gastrectomy for gastric cancer

“…Until the middle of the 20th century, surgeons had been primarily concerned with preventing severe surgical complications of gastrectomy [3]. TG results in risk of postgastrectomy syndrome, such as weight loss, dumping syndrome, reflux esophagitis, gall stones, and a reduction in the quality of life [3,4]. The ideal reconstruction procedure (RP) after TG should replace all lost functions of the stomach [4].…”

“…TG results in risk of postgastrectomy syndrome, such as weight loss, dumping syndrome, reflux esophagitis, gall stones, and a reduction in the quality of life [3,4]. The ideal reconstruction procedure (RP) after TG should replace all lost functions of the stomach [4]. Many RPs have been described in literature.…”

Reconstruction after gastrectomy: Which technique is best?

“…The feasibility of a distal reservoir was shown recently without any advantage as compared with a proximal reservoir [62,64,71]. Results in terms of quality of life and gain of weight in the study by Gioffre et al were in favor of performing a double reservoir [62], but this contrasts with other studies [45,59,60].…”