Postoperative evaluation of the jejunal pouch reconstruction following proximal and distal gastrectomy for cancer.

Background/Aims: To evsluate the efficacy of the jejunal pouch reconstruction following subtotal proximal and distal gastrectomy, a retrospective study examining the postoperative condition of patients who underwent different methods of reconstruction after gastrectomy for cancer was undertaken. Methodology: Various parameters indicative of postoperative function were evaluated at one year postoperatively, and two major groups were examined. The proximal gastrectomy group was composed of patients who underwent either 1) proximal gastrectomy with an interpused jejunal pouch (PG-pouch), 2) proximal gastractomy with simple jejunal interposition (PG-inter), or 3) total gastrectomy with simple jejunal interposition (TG). The distal gastrectomy group was composed of patients who underwent either 4) distal gastrectomy with an interposed jejunal pouch (DG-pouch), 5) distal gastractomy with simple jejunal interposition (DG-inter), or 6) distal gastrectomy with Billcoth 1 reconstruction (B-1). Results: Volume of meal intake was better preserved and the incidence of abdominal symptoms were less frequent in the PG-pouch and DG-pouch groups. In the PG-inter, DG-inter and DG-pouch groups, none of the patienis experienced heartburn or had endoscopic findings consistent with reflux esophagitis, while 2 patients (20.0%) in the PG-pouch group complained of hearthurn with evidence of reflux esophagitis on endoscopy. Increase in blood acetaminophen level was milder in both the PG-pouch and DG-pouch groups, signifying improved gastric emptying. Conclusions: The jejunal pouch interposition following proximal and distal gastrectomy seems to confer clinical benefit in terms of postoperative function, especially in the form of meal intake, abdominal symptoms, and gastric emptying. The side effect of an improved reservoir may be the incidence of reflux esophagitis seen in 2 patients in the PG-pouch group.