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Gong J, Liu X, Wang G, Li W, Luo G, Lin Y, Zhang B, Chen C. Uncut interposed jejunum pouch versus esophago-gastrostomy and double anastomoses of jejunum to the esophagus and residual stomach: An innovative method of digestive tract reconstruction following proximal gastrectomy. Asian J Surg 2023; 46:4196-4201. [PMID: 36456439 DOI: 10.1016/j.asjsur.2022.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
AIM An innovative method of digestive tract reconstruction following proximal gastrectomy, the uncut interposed jejunum pouch, esophagus and residual stomach double anastomosis(Uncut-D), was established in recent years. In order to fully clarify the superiority of the procedure, this study has conducted a systematic analysis and thorough discussion. METHODS 118 patients with adenocarcinoma of the esophagogastric junction who underwent proximal gastrectomy were enrolled in this study. According to the methods of digestive tract reconstruction, these patients were divided into three groups: Uncut-D(n = 43), esophagogastrostomy (EG, n = 36), jejunal interposition (JI, n = 39).The preoperative indicators, surgical complications and related indicators of postoperative quality of life were analyzed. RESULTS There were no significant differences in preoperative data among all groups (P > 0.05); The digestive tract reconstruction time in Uncut-D group was more than that in EG group, and less than that in JI group (P < 0.05). The incidence of esophageal anastomotic stenosis in Uncut-D group was significantly lower than that in EG group (P < 0.05); In Uncut-D group, the incidence of reflux esophagitis, postoperative nutrition index(PNI), weight recovery and Visick classification were significantly better than those in EG group (P < 0.05), furthermore, the incidence of delayed gastric emptying,PNI and weight recovery were better than those in JI group (P < 0.05). CONCLUSIONS The Uncut-D procedure gave full play to jejunal continuity and the advantages of pouch, and played a valuable role in gastric and cardiac replacement, which significantly reduced long-term complications, improved postoperative nutritional status of patients and long-term quality of life.
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Affiliation(s)
- JiaQing Gong
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China.
| | - Xia Liu
- Department of Medical Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - GuangLan Wang
- Department of Ultrasound,The General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - Wei Li
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
| | - GuoDe Luo
- Department of General Surgery, The General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - Yan Lin
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
| | - Bin Zhang
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
| | - ChuanDong Chen
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
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Lu J, Wu Z, Liu G, Wang B, Shi L. The clinical effectiveness of the method by establishing a proximal jejunum pouch after laparoscopic total gastrectomy: A propensity score-based analysis. Asian J Surg 2021:S1015-9584(21)00374-2. [PMID: 34315672 DOI: 10.1016/j.asjsur.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In this study, we propose an improved Roux-en-Y (RY) surgical method by constructing a proximal jejunum pouch (PP-RY). Postoperative results were evaluated among patients with gastric cancer who underwent PP-RY and standard RY anastomosis. METHODS The clinical data of patients with gastric cancer who underwent laparoscopic total gastrectomy (LTG) in our center from May 2019 to May 2020 were collected retrospectively. We compared the short-term results of patients in the PP-RY and RY groups using 1:1 propensity score matching (PSM). RESULTS A total of 317 patients were selected, including those who received RY (n = 249) or PP-RY (n = 68) after LTG. After PSM, both groups had a sample size of 68. During the one-year follow-up period, the incidences of postoperative dumping syndrome (5.6%) and reflux esophagitis (14.8%) were significantly lower in the PP-RY group (P = 0.001 and P = 0.010, respectively). Weight loss (6.5 ± 2.0 kg) and albumin decrease (0.2 ± 0.1 g/dl) were significantly lower (P = 0.038 and P < 0.001, respectively), and the prognostic nutritional index (PNI) was significantly higher in the PP-RY group (P = 0.009). In the QLQ-C30 scale, the degree of anorexia in the PP-RY group was significantly lower than that in the RY group (P<0.05). In the QLQ-STO22 scale, chest and abdomen pain, dietary restriction, and anxiety were significantly lower in the PP-RY group (all P<0.05). CONCLUSION PP-RY can lead to obvious improvements in nutritional status, reduce short-term complications, and improve quality of life (QoL) for patients after LTG.
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Yamashita R, Takahashi N, Tsuboi K, Mitsumori N, Kashiwagi H, Yanaga K. Impact of truncal vagotomy on complicated peptic ulcer after distal gastrectomy with reconstruction by jejunal pouch interposition. Surg Case Rep 2020; 6:123. [PMID: 32488527 PMCID: PMC7266894 DOI: 10.1186/s40792-020-00879-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We encountered a case of marginal ulcer in the jejunum after distal gastrectomy with jejunal pouch interposition. However, it has not been reported and not confirmed the treatment. We chose truncal vagotomy, considering reduced morbidity and postoperative complications. CASE PRESENTATION A case was a 69-year-old woman who was admitted to our hospital with melena. She had received curative distal gastrectomy with a 15-cm jejunal pouch reconstruction for early gastric cancer. Marginal ulcer in the jejunal pouch was detected by upper gastrointestinal endoscopy. She was given medication; however, she repeated hospitalization for melena and abdominal pain. Therefore, we decided to perform surgery, and truncal vagotomy was performed. The patient's postoperative course was uneventful and was discharged on the 22nd postoperative day. Symptoms such as abdominal pain and melena were improved after truncal vagotomy. CONCLUSION We presented a case with a complicated peptic ulcer after distal gastrectomy with reconstruction by jejunal pouch interposition, which was successfully treated by truncal vagotomy, a surgical acid-reducing procedure which does not require resection of remnant stomach.
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Affiliation(s)
- Reika Yamashita
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba Prefecture, 277-8567, Japan
| | - Naoto Takahashi
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba Prefecture, 277-8567, Japan.
| | - Kazuto Tsuboi
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba Prefecture, 277-8567, Japan
| | - Norio Mitsumori
- Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Hideyuki Kashiwagi
- Department of Surgery, Fuji City General Hospital, Fuji, Shizuoka Prefecture, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
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Chen W, Jiang X, Huang H, Ding Z, Li C. Jejunal pouch reconstruction after total gastrectomy is associated with better short-term absorption capacity and quality of life in early-stage gastric cancer patients. BMC Surg 2018; 18:63. [PMID: 30126403 PMCID: PMC6102876 DOI: 10.1186/s12893-018-0397-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/15/2018] [Indexed: 12/29/2022] Open
Abstract
Background No consensus exists regarding the best reconstruction style after total gastrectomy (TG). Roux-en-Y oesophagojejunostomy is a simple option for gastrointestinal tract reconstruction. Recently, jejunal pouch reconstruction has been suggested as an appropriate approach. We compared the postoperative outcomes of the two surgical approaches using a well-characterized cohort of gastric carcinoma patients. Methods A total of 60 patients who underwent TG were divided into two groups according to the reconstruction style. Both groups were compared regarding patient characteristics, perioperative data and quality of life (QoL), which was assessed using the Spitzer QoL index (QLI) and Visick grade. The incidence of long-term surgery-related complications, including reflux oesophagitis, dumping syndrome, and retention syndrome, was also compared to evaluate postoperative restoration. Results Both study groups were comparable with respect to general patient characteristics. No mortality or no significant differences in surgery-related data were found except in the operation time. Compared to Orr Roux-en-Y reconstruction, pouch reconstruction was associated with a longer procedure time, a lower incidence of dumping/retention syndrome and better QoL parameters (p < 0.05). Conclusion In this study, jejunal pouch reconstruction after TG was superior to the traditional Roux-n-Y oesophagojejunostomy with respect to improved dietary intake and QoL.
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Affiliation(s)
- Wei Chen
- Department of Gastrointestinal Surgery, The Central Hospital of the Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China
| | - Xumian Jiang
- Department of Gastrointestinal Surgery, The Central Hospital of the Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China.
| | - Hui Huang
- Department of Gastrointestinal Surgery, The Central Hospital of the Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China
| | - Zao Ding
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430014, People's Republic of China
| | - Chihua Li
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Wuhan, 430014, People's Republic of China
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Ito Y, Yoshikawa T, Fujiwara M, Kojima H, Matsui T, Mochizuki Y, Cho H, Aoyama T, Ito S, Misawa K, Nakayama H, Morioka Y, Ishiyama A, Tanaka C, Morita S, Sakamoto J, Kodera Y. Quality of life and nutritional consequences after aboral pouch reconstruction following total gastrectomy for gastric cancer: randomized controlled trial CCG1101. Gastric Cancer 2016; 19:977-85. [PMID: 26272278 DOI: 10.1007/s10120-015-0529-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/28/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total gastrectomy has detrimental effects on postoperative nutritional status and quality of life (QOL), but it is often unavoidable in the treatment of gastric cancer. Roux-en-Y (RY) is the most common reconstruction method following total gastrectomy. Trials to explore other means of reconstruction have been conducted but have failed to identify a method that is globally accepted. METHODS Aboral pouch reconstruction (AP), in which an anisoperistaltic jejunal pouch is created in the Y limb of the RY reconstruction, is considered effective and technically feasible. A prospective randomized trial was conducted to compare AP with RY. Gastric cancer patients requiring total gastrectomy for R0 resection were randomly assigned during surgery to receive either RY (n = 51) or AP (n = 49). Postoperative QOL as assessed by the EORTC QLQ-C30 and STO22, body composition, and morbidity were compared between the two reconstruction methods. The physical functioning score of the QLQ-C30 was selected as the primary endpoint. RESULTS The incidences of postoperative complications were similar between the two groups (29 % in the RY group and 27 % in the AP group). No significant difference was observed in the physical functioning score, and the superiority of AP was demonstrated only for the nausea and vomiting score at 12 months (p = 0.041) and the reflux score at 1 month (p = 0.036). No significant differences were observed in body composition or serum biochemistry. CONCLUSIONS Although AP was safely implemented, no increased benefits in nutritional or QOL-related parameters were observed for this method over RY within 12 months postoperatively.
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Affiliation(s)
- Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Chuo Hospital, Nagoya, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Michitaka Fujiwara
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kojima
- Department of Gastroenterological Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Japan
| | - Takanori Matsui
- Department of Gastroenterological Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Japan
| | | | - Haruhiko Cho
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Toru Aoyama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Chuo Hospital, Nagoya, Japan
| | - Kazunari Misawa
- Department of Gastroenterological Surgery, Aichi Cancer Center Chuo Hospital, Nagoya, Japan
| | | | - Yuki Morioka
- Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | | | - Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Brenkman HJF, Correa-Cote J, Ruurda JP, van Hillegersberg R. A Step-Wise Approach to Total Laparoscopic Gastrectomy with Jejunal Pouch Reconstruction: How and Why We Do It. J Gastrointest Surg 2016; 20:1908-1915. [PMID: 27561635 PMCID: PMC5078159 DOI: 10.1007/s11605-016-3235-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/02/2016] [Indexed: 02/06/2023]
Abstract
Laparoscopic gastrectomy (LG) is a safe alternative compared to open gastrectomy for cancer. To increase the uptake of minimally invasive approaches and facilitate their analysis and improvement a stepwise approach is warranted. This study describes our technique and experiences total laparoscopic gastrectomy (TLG) with jejunal pouch reconstruction for gastric cancer. Technical modifications throughout the years were described. In patients with anastomotic leakage, the CT-scan and reoperation report were reviewed to identify the location and cause of the leak. A total of 47 patients who underwent laparoscopic total gastrectomy with extracorporeal jejunal pouch reconstruction and stapled circular esophagojejunostomy from May 2007 to August 2015 were prospectively analyzed. A stepwise approach of 10 steps was designed based on video and case analysis. Median operation time was 301 (148-454) minutes and median blood loss was 300 (30-900) milliliters. Anastomotic leakage occurred in six (12.8 %) patients; additionally, one (2.12 %) jejunal-pouch staple line leak was identified. An important modification in our technique was a purse-string suture around the anvil of the circular stapler to prevent esophageal mucosa to slip away. After this modification, the leakage rate was reduced to 7 % in the last 15 procedures. In conclusion, TLG with jejunal pouch reconstruction is a feasible procedure in a selected group of patients. Our stepwise approach and technique may help surgeons to introduce jejunal pouch reconstruction during laparoscopic gastrectomy in their center.
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Affiliation(s)
- Hylke J. F. Brenkman
- Department of Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands
| | - Juan Correa-Cote
- Department of Surgical Oncology, Hospital Pablo Tobón Uribe, Calle 78 B #, 69 - 240 Medellín, Colombia ,Department of Surgical Oncology, University of Toronto, Room 3-130, 610 University Avenue, Toronto, ON M5G 2M9 Canada
| | - Jelle P. Ruurda
- Department of Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands
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Abstract
Total gastrectomy for cancer results in many digestive troubles leading to an impairement of the quality of life. Different types of reconstruction have been proposed to improve the postoperative digestive functions. According to several prospective randomized trials and a recent meta-analysis, the Roux-en-Y jejunal pouch construction appears to be the best technique for reconstruction concerning the postoperative quality of life. However, this safe reconstructive surgery is not still recognized as a gold standard.
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Affiliation(s)
- Alexandre Doussot
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - Baptiste Borraccino
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - Patrick Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - Olivier Facy
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
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Mongin C, Zinzindohoue F. Jejunal J-pouch with Roux-en-Y esophagojejunostomy after total gastrectomy. J Visc Surg 2013; 150:341-4. [PMID: 24183817 DOI: 10.1016/j.jviscsurg.2013.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- C Mongin
- Service de chirurgie digestive, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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