Total gastrectomy: Nutritional status after different reconstruction techniques. An experimental study

Abstract

The authors report their experimental studies on early nutritional changes in 30 gastrectomized rats where intestinal continuity was restored by three different reconstruction methods, i.e., exclusion of the duodenum from alimentary transit (Sweet-Allen method), or duodenal recanalization (Longmire method) or double duodenal and jejunal recanalization (Moricca method). Ten sham operated rats were used as controls. Results showed that the group of rats which underwent Longmire's reconstruction presented better nutritional parameters (body weight gain, daily food intake, feeding efficiency, albuminemia) than the Moricca and Sweet-Allen reconstruction groups. These results became statistically significant when follow up was extended to 18 months by using an actuarial method. However, perioperative mortality rate was highest in the Longmire reconstruction group.

Fat absorption after total gastrectomy in rats submitted to Roux-en-Y or Rosanov-like double-transit technique

“…These results are quite understandable, since in Billroth I there is transit through the duodenum 19,36 . Such results were also achieved experimentally, in rats submitted to gastrectomy and different reconstructive techniques 2,24 . Adequate fat absorption after gastrectomy depends fundamentally on how fat reaches the small bowel.…”

“…The etiopathogeny of this kind of steatorrhea depends on many combination possibilities of technical resection and transit reconstruction that change the anatomy and physiology of the digestive tract. In this sense, many are the etiological factors that add up 1,4,9,10,22,23,24,26,38 and may lead to variable degrees of steatorrhea 19,27 . 1.…”

“…This study used the Roux-en-Y as the parameter of comparison to the modified Rosanov technique, as it is the most used reconstructive technique after total gastrectomy worldwide 5,24,26 . We showed, as we already supposed based on previous knowledge of the literature, that duodenumpreserving reconstructive techniques, specifically the modified Rosanov technique, showed lower malabsorption and steatorrhea.…”

“…the gastrectomy , many technical alternatives have appeared in the history of gastric surgery. Nowadays, the routine of transit reconstruction after total gastrectomy is still the Roux-en-Y technique, because of technical simplicity and low risk of duodenal stump fistulas 24 . The Rosanov technique is similar to Roux-en-Y, but instead of closing the duodenal stump with suture, a lateral-terminal anastomosis between jejunum and duodenum is made with ligation of the it was expected that malabsorption, diarrhea and steatorrhea would be minimized after total gastrectomy.…”

Gastrectomy in the Rat Using Two Modifications of Esophagojejunal Anastomosis

“…Numerous nutritional, metabolic and hormonal disturbances develop after GX, and clinical and experimental studies have repeatedly been carried out to evaluate them [1][2][3][4][5]. Earlier studies on GX, performed in several experimental animal species [1,[4][5][6][7][8][9][10], provided insight into metabolic, functional and structural changes in the absence of neoplastic or ulcerative processes in the stomach.…”