Lebensqualität nach totaler Gastrektomie und Jejunuminterposition mit und ohne Pouch

Büchin, P.; Faß, J.; Dreuw, B.; Cleuziou, Juliette; Schumpelick, Volker

doi:10.1007/978-3-642-72132-8_47

Cited by 1 publication

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“…Bei derzeit noch geringer Patientenzahl (n = 26) läût sich allerdings noch keine abschlieûende Empfehlung für eines der Verfahren aus-sprechen [4]. In einer noch nicht abgeschlossenen randomisierten Studie werden die alleinige Dünndarminterposition mit der Pouchinterposition unter Verwendung der Oesophagojejunoplicatio verglichen.…”

Section: Refluxprophylaxeunclassified

Intestinale Pouches: Magenersatz

Schuhmacher

Böttcher

Siewert

1999

Chirurg

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Reconstruction of the intestinal passage after a total gastrectomy is usually based on a direct esophagojejunostomy with end-to-side implantation of the afferent loop. The second principle of reconstruction is based on preservation of the duodenal passage. Long-term problems such as weight loss and malnutrition are further considerations that lead to the concept that gastric reconstruction should have the form of a reservoir. In addition to the construction of the reservoir itself, the clinical concern of avoiding gastroesophageal reflux is a further requirement for the choice of reconstruction type. Diversion of the duodenal content via a Roux-en-Y end-to-side anastomosis is considered to be the standard procedure. Interposition of a sufficiently long duodenal loop with maintenance of the duodenal passage also has the effect of preventing duodenal reflux. A theoretical advantage of this procedure is the linking of the motility of the duodenum with that of the interposed segment with improved synchronization of the aboral nutrient passage. When one considers complicated reconstructive procedures, the present literature suggests construction of a pouch is definitely functionally superior to the simple esophagojejunostomy. Whether the duodenal passage should be maintained or whether a Roux-Y technique should be used is a question that is still open for discussion.

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Section: Refluxprophylaxeunclassified