Treatment of Devastating Postgastrectomy Symptoms: The Potential Role of Jejunal Pouch Reconstruction

Abstract

After gastrectomy a few patients develop severe symptoms and malnutrition. There are probably several reasons for this, such as insufficient gastric reservoir function, malassimilation, diarrhea and dumping. The patient presented here developed severe malnutrition after partial gastrectomy and his weight gradually decreased from 95 to 40 kg during the first 6 postoperative years. His major complaint was postprandial vomiting and early satiety. During the course of his illness, he was repeatedly investigated with computerized tomography scans, repeated endoscopies with biopsies, barium examinations, etc. Finally the only positive finding was bacterial intestinal overgrowth, but antibiotic treatment did not improve his condition. After repeated periods of parenteral nutrition or enteral tube feeding, an S-shaped jejunal pouch was attached to the gastric remnant. Dual-energy X-ray absorptiometry was used to examine the body composition and bone density in the immediate postoperative period and 1 year after the operation. During the first postoperative year he gained 11 kg weight and reported an essentially normal food intake. Both laboratory and clinical parameters improved and a gain in lean body mass was recorded. Patients with severe postgastrectomy symptoms, with no other plausible explanation than nonexistent or insufficient gastric reservoir function, may benefit from re-reconstruction with a jejunal pouch.

Long-term Shifting Patterns in Quality of Life After Distal Subtotal Gastrectomy

“…Eating restrictions may be ameliorated by establishing a food reservoir during surgery. [19][20][21] Although this hypothesis was not tested in this study, previous studies suggest possible advantages of pouch reconstruction on gastric function preservation. A case study of the long-term outcomes of a Hunt-Lawrence jejunal pouch for congenital microgastria was conducted, 22 and good quality of life with normal oral intake was reported.…”

About reduodenization of digestive tract in gastrectomy

“…Следствием этих изменений являются новые условия функционирования для всей пищеварительной системы. По данным литературы, у 30-86% больных, успешно перенесших гастрэктомию, в течение многих месяцев и лет наблюдается комплекс постгастрэктомических осложнений, таких как демпинг-синдром (14-82%), агастральная астения (30-40%), гипогликемический синдром (7-13%), рефлюксэзофагит (7-18%), синдром приводящей кишки (3,5-16%), стриктура пищеводно-кишечного анастомоза (3-7%) [15][16][17][18][19]. Стремление улучшить непосредственные и отдаленные результаты гастрэктомии сопровождалось попытками поддержать естественные анатомо-физиологические отношения органов желудочно-кишечного тракта, уменьшив ущерб пищеварению, наносимый хирургической перестройкой взаимоотношений органов пищеварительной системы.…”

“…Преимущества вариантов гастропластики с включением двенадцатиперстной кишки в зону прохождения пищевых масс, казалось бы, очевидны, однако после гастрэктомии у большого числа больных, которым была выполнена еюногастропластика с созданием трансплантата между пищеводом и двенадцатиперстной кишкой, наблюдаются явления демпинг-синдрома и рефлюкс-эзофагита [18,29]. Причина этого заключается в том, что демпинг-синдром возникает именно вследствие раздражения интерорецепторов двенадцатиперстной кишки, этот факт и был доказан в эксперименте.…”

Laparoscopy-Assisted Distal Gastrectomy with Jejunal Pouch Interposition

“…In addition to these reconstruction methods, many variations of JIP have also been reported. 4 The length and volume of JPI, the shape of the JPI, and the volume of remnant stomach may affect postoperative QOL. Because DG with JPI reconstruction is derived from DG with B-I reconstruction and not B-II reconstruction, B-I reconstruction should be use as a control to clarify the effect of JPI on postoperative QOL.…”