Complications after proximal gastrectomy with jejunal pouch interposition: Report of a case

Katšube, Takao; Konno, Satoshi; Hamaguchi, Katsuhiko; Shimakawa, Takeshi; Naritaka, Yoshihiko; Ogawa, Kenji

doi:10.1016/j.ejso.2005.07.009

Cited by 27 publications

(32 citation statements)

References 5 publications

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“…These results indicate that the JPI-P reconstruction appears to have advantages in comparison with JI-P, while any benefit of JPI-P compared with esophagogastrostomy remains uncertain. It should be noted that the jejunal pouch was extremely dilated in some patients after JPI-P and a reoperation was often necessary in this condition [40, 41]. …”

Section: Resultsmentioning

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: Resultsmentioning

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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“…They concluded that excessive food ingestion caused irreversible pouch dilatation, and highlighted the importance of nutritional instruction for patients after surgery. In another study, Katusube et al reported excessive dilation of a jejunal pouch 4.5 years after surgery in a 44-yearold male patient 19) . These authors found no abnormality at the anastomosis or pylorus of the stomach other than food residues in the dilated pouch, which is the same finding as in the present patient.…”

Section: Discussionmentioning

confidence: 99%

“…These authors found no abnormality at the anastomosis or pylorus of the stomach other than food residues in the dilated pouch, which is the same finding as in the present patient. From other viewpoints, Katusube et al discussed the importance of related factors, such as the role of vagal nerve preservation, pyloroplasty, and motility of the intestine, in overcoming complications after this procedure 19) . In terms of mortality, an animal experiment of JPI after proximal gastrectomy has revealed the relatively early and persistent recovery of the jejunal pouch, remnant stomach, and jejunum 20) .…”

Section: Discussionmentioning

confidence: 99%

Dilation and stasis: a rare but important late complication of jejunal pouch interposition after proximal gastrectomy

Maeda

Namikawa

Munekage

et al. 2017

Ann. Cancer Res. Therap.

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Jejunal pouch interposition (JPI) after proximal gastrectomy is occasionally chosen due to superiority in terms of food intake volume and prevention of reflux esophagitis early after surgery. Although the early complications have been reported in the literature, the longterm results and late complications of the procedure are not well known. Herein we described a patient who suffered from dilatation and stasis of the interposed jejunal pouch after proximal gastrectomy. Based on two previous cases and the present study, the dilation of the pouch is irreversible, requiring surgical resection of the dilated pouch. Our experience highlights the need for further investigations to elucidate the long-term outcomes of proximal gastrectomy with JPI. IntroductionProximal gastrectomy is occasionally chosen for the treatment of gastric cancer located in the upper one-third of the stomach, with the aim of preserving gastric digestion 1,2) . Treatment efficacy is the prerequisite for this uncommon procedure. A retrospective study of 128 patients with a preoperative diagnosis of early gastric cancer demonstrated that the outcome of proximal gastrectomy reached the standards in terms of tolerability and tumor curability 3) . There are various reconstruction techniques that can be used after proximal gastrectomy, including esophagogastrostomy, jejunal interposition, double tract, and jejunal pouch interposition (JPI). A nationwide survey in Japan revealed that JPI was the most common reconstruction method in only 7% of 154 institutes surveyed; in comparison, 49% of institutes reported esophagogastrostomy as the most common technique 4) . However, to prevent reflux esophagitis, jejunal interposition is generally required when the remnant stomach is less than onethird of the entire stomach 4) . In this context, although it is not frequently performed, the interposition of the jejunum with or without pouch formation remains an important reconstruction option. Moreover, recent studies indicate that the frequency of tumors located in the upper one-third of the stomach is increasing [5][6][7] suggesting that there will also be an increase in the number of patients Abstract Reports suggest that jejunal pouch interposition (JPI) after proximal gastrectomy is superior in terms of food intake volume and prevention of reflux esophagitis early after surgery. However, the long-term results and late complications of the procedure are not well known. This case report describes an excessive pouch dilatation necessitating surgical intervention as a late complication of JPI. The patient was a 62-year-old woman with early gastric cancer who underwent proximal gastrectomy. Gastrointestinal continuity was restored with JPI. The patient's postoperative course was uneventful and follow-up imaging studies showed no signs of tumor recurrence. However, the patient gradually started to experience difficulty eating food and complained of postprandial nausea and vomiting. Contrast radiography of the upper gastrointestinal tract revealed a dilated jejunal po...

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“…To prevent or minimize postgastrectomy complications, proximal gastrectomy with an interposed jejunal pouch has been advocated as an organ-preserving strategy to improve QOL [13,[23][24][25] . However, there some studies have shown that patients with an interposed jejunal pouch need a second operation because of food stasis or disordered gastric emptying, and the length of the jejunal pouch is still under discussion [26][27][28] . To avoid postoperative symptoms, there is no consensus on the need for pyloroplasty after proximal gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction

Zhang¹,

Sun²,

Xu³

et al. 2009

WJG

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AIM:To compare postoperative quality of life (QOL) in patients with gastric cancer treated by esophagogastrostomy reconstruction after proximal gastrectomy.METHODS: QOL assessments that included functional outcomes (a 24-item survey about treatmentspecific symptoms) and health perception (Spitzer QOL Index) were performed in 149 patients with gastric cancer in the upper third of the stomach, who had received proximal gastrectomy with additional esophagogastrostomy. RESULTS:Fifty-four patients underwent reconstruction by esophagogastric anterior wall end-to-side anastomosis combined with pyloroplasty (EA group); 45 patients had reconstruction by esophagogastric posterior wall end-to-side anastomosis (EP group); and 50 patients had reconstruction by esophagogastric end-to-end anastomosis (EE group). The EA group showed the best postoperative QOL, such as recovery of body weight, less discomfort after meals, and less heart burn or belching at 6 and 24 mo postoperatively. However, the survival rates, surgical results and Spitzer QOL index were similar among the three groups. CONCLUSION:Postoperative QOL was better in the EA than EP or EE group. To improve QOL after proximal gastrectomy for upper third gastric cancer, the EA procedure using a stapler is safe and feasible for esophagogastrostomy.

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Complications after proximal gastrectomy with jejunal pouch interposition: Report of a case

Cited by 27 publications

References 5 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

Dilation and stasis: a rare but important late complication of jejunal pouch interposition after proximal gastrectomy

Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction

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