Reconstruction of the gastrointestinal tract after total gastrectomy

Abstract

Currently, there are more than 70 types of restoration of gastrointestinal tract (GIT) continuity. Reconstruction of the digestive tract is an important part of surgery on par with lymph node dissection and it must have the following characteristics: gradual emptying into the small intestine, prevention of reflux esophagitis and dumping syndrome, small reservoir size, and reconstructive operative procedures should be relatively uncomplicated and not time-consuming. The technique of GIT reconstruction is the determining factor of postoperative quality of life for the patients. According to the Japanese guidelines, there're two types of reconstruction: with preservation of the duodenal passage and without it. The most known techniques in the duodenal passage exclusion group are Roux-en-Y reconstruction and Roux-en-Y reconstruction with pouch formation. In the duodenal passage preservation group interposition of the jejunum with and without pouch formation are the most common. Currently, Roux-en-Y reconstruction is the preferred technique. The use of Roux-en-Y reconstruction with a pouch to recover the initial anatomical structure significantly decreases the incidence of dumping syndrome and doesn't increase the number of postoperative complications or mortality, operative time, hospitalization time, and significantly increases patients' quality of life. For laparoscopic total gastrectomy, it was shown that intracorporeal anastomosis has a better cosmetic appearance, it's safer, technically feasible, less invasive compared to the extracorporeal anastomosis. Reconstruction using the OrVil device should be used in patients with tumors of the cardia or lower third of the esophagus because anastomosis can be formed high in the mediastinum which increases the probability of negative proximal resection margin after gastrectomy.

A review on double tract reconstruction after proximal gastrectomy for proximal gastric cancer

“…There are conflicting reports of who invented the DTR technique, but a study reports that it was first mentioned by Japanese surgeons Kajitani and Sato [ 9 ]. DTR is classified as a duodenal preserving reconstructive method because it maintains the passage of food into the duodenum for digestion [ 10 ].…”