Optimal gastric pouch reconstruction post-gastrectomy

Nanthakumaran, Shayanthan; Suttie, Stuart; Chandler, H.W.; Park, Kenneth G. M.

doi:10.1007/s10120-007-0450-7

Cited by 4 publications

(6 citation statements)

References 17 publications

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“…Based on these physiological estimations, the authors recommended that more studies adopt a 15 cm pouch design. 62 In conclusion, the results of our meta-analysis support the use of a pouch as a gastric substitute after total gastrectomy. Pouch creation improves functional and nutritional outcomes, without incurring greater perioperative morbidity.…”

Section: Quality Of Life (Giqli) -6 Monthsupporting

confidence: 60%

“…61 Furthermore, 1 included study defined a pouch size of 12.5 cm as ''large''. 61 At present, perhaps some insight into this issue may derive from mathematical calculations by Nanthakumaran et al, 62 who proposed that the volume of a J-pouch expands most when its length increases to 15 cm, but tapers thereafter. The investigators found that pouch sizes of 5 to 10 cm cannot accommodate 350 to 400 mL (approximate meal volume in elderly patients) unless high intraluminal pressures of $45 cmH 2 O is applied, but observed that pouch lengths of 15 to 20 cm readily received this volume even at basal pressures of $15 cmH 2 O.…”

Section: Quality Of Life (Giqli) -6 Monthmentioning

confidence: 99%

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Pouch Versus No Pouch Following Total Gastrectomy: Meta-analysis of Randomized and Non-randomized Studies

et al. 2019

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Objective: The aim of the study was to assess the impact of pouch reconstruction on perioperative outcomes, postprandial symptoms, nutritional and anthropometric parameters, and overall quality of life after total gastrectomy for gastric malignancy. Summary Background Data: The short-term perioperative risks and longer term functional value of creating a small-bowel reservoir after total gastrectomy are contended. Methods: A search for randomized and non-randomized studies comparing reconstruction with or without a pouch was conducted. Treatment effects were computed using pairwise random-effects meta-analysis and meta-regression, and the systematic review was conducted in accordance with PRISMA and MOOSE guidelines. Results: A total of 17 randomized trials and 8 observational studies involving 1621 participants were included. Pouch creation is associated with an increased operation time [259.3 vs 235.8 min; weighted mean difference (WMD) 23.5, 95% confidence interval (CI) 9.8-37.2], but not hospitalization duration. There was no difference in overall postsurgical complications, including anastomotic leak and abdominal abscess. Pouch formation markedly reduces the risk of dumping syndrome at 3 to 6 months [8.1% vs 32.4%; risk ratios (RR) 0.36, 95% CI, 0.21-0.60] and 12 to 24 months (2.8% vs 23.6%; RR 0.27, 95% CI, 0.16-0.46). The functional advantages of pouch reconstruction persist at 1 to 2 years, with aggregated data indicating considerably lower risks of esophagitis and heartburn (63% relative reduction), dumping syndrome (73% relative reduction), and food intake disturbance (50% relative reduction). At 12 to 24 months, albumin levels (40.5 vs 37.9 g/L; WMD 2.59, 95% CI, 1.35-3.84) and body mass index (22.2 vs 20.9 kg/m 2 ; WMD 1.28, 95% CI, 0.61-1.94) are significantly higher among participants with a pouch. Conclusions: Pouch creation improves long-term functional and nutritional outcomes after total gastrectomy, without greater perioperative morbidity.

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Section: Quality Of Life (Giqli) -6 Monthsupporting

confidence: 60%

Section: Quality Of Life (Giqli) -6 Monthmentioning

confidence: 99%

Pouch Versus No Pouch Following Total Gastrectomy: Meta-analysis of Randomized and Non-randomized Studies

et al. 2019

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“…for a 15 cm pouch, this volume was easily achieved at a pressure of 15 cm H 2 O. 33 Therefore, our results may indicate that, not only the position of the pouch, but also the size of the pouch affected QOL of TG patients. Further studies are required to determine the optimal pouch sites and sizes.…”

Section: Discussionmentioning

confidence: 58%

Effects of creating a jejunal pouch on postoperative quality of life after total gastrectomy: A cross‐sectional study

Tsuji

Isobe

Seto

et al. 2021

Annals of Gastroent Surgery

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Aim Total gastrectomy results in the complete loss of gastric function and the development of severe postgastrectomy syndrome. During the jejunal pouch procedure following total gastrectomies, a substitute stomach is created to alleviate the effects of postgastrectomy syndrome. However, the procedure's effectiveness remains controversial. This study aimed to explore the effect of jejunal pouch creation after total gastrectomy on postoperative quality of life. Methods A nationwide multi‐institutional cross‐sectional study, the Postgastrectomy Syndrome Assessment study NEXT, used the Postgastrectomy Syndrome Assessment Scale‐45 questionnaire to explore the optimal gastrectomy procedure for cancer located in the upper third of the stomach or around the esophagogastric junction. The questionnaire consists of 45 items consolidated into 19 main outcome measures relating to postgastrectomy symptoms, amount of food ingested, quality of ingestion, ability for working, level of satisfaction for daily life, and the physical and mental component summary of the 8‐Item Short Form Health Survey. Eligible completed questionnaires were retrieved from 1909 patients. Of these, the data were analyzed for 1020 patients who underwent total gastrectomy and 93 patients who underwent jejunal pouch creation after total gastrectomy. Results Postoperative quality of life was compared between patients with and without pouches. The analysis revealed that patients with pouches, particularly oral pouches, experienced substantially improved postoperative quality of life than those without, even after adjusting for several clinical factors using multiple regression analyses. Conclusion The results suggest that total gastrectomy with jejunal pouch creation, particularly oral pouches, may significantly improve postoperative quality of life.

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“…Most studies have described a pouch of about 15 cm in length, so any comments regarding the optimal length of the pouch must be considered anecdotal, at best [22]. Tono et al and Tanaka et al [23,24] both stated that pouches longer than 15 cm may contribute to symptoms of stasis, and their observations substantiate this.…”

Section: Total Gastrectomymentioning

confidence: 80%

“…Tono et al and Tanaka et al [23,24] both stated that pouches longer than 15 cm may contribute to symptoms of stasis, and their observations substantiate this. 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].…”

Section: Total Gastrectomymentioning

confidence: 98%

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

et al. 2012

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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.

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Optimal gastric pouch reconstruction post-gastrectomy

Cited by 4 publications

References 17 publications

Pouch Versus No Pouch Following Total Gastrectomy: Meta-analysis of Randomized and Non-randomized Studies

Pouch Versus No Pouch Following Total Gastrectomy: Meta-analysis of Randomized and Non-randomized Studies

Effects of creating a jejunal pouch on postoperative quality of life after total gastrectomy: A cross‐sectional study

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

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