J Korean Surg Soc.  2003 Oct;65(4):295-300.

Proximal Gastrectomy Reconstructed by Jejunal Pouch Interposition: Surgical Technique and Evaluation of Postoperative Function

Affiliations
  • 1Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. chyoo63@naver.com

Abstract

PURPOSE
Total gastrectomy has generally been performed for the treatment of upper third gastric cancer. However, the optimal extent of resection for the upper third gastric cancer is controversial until now. This article describes the surgical techniques and postoperative status for proximal gastrectomy reconstructed by jejunal pouch interposition. METHODS: We have used interposition of a double jejunal pouch between the esophagus and the remnant stomach after performing proximal gastrectomy in 22 patients to date. The postoperative courses were compared with those of 23 patients who underwent total gastrectomy during the same period. RESULTS: The age of the patients ranged from 28 to 72 years (mean 56.4 years); 18 were men and 4 were women. The lesions were mostly located along the lesser curvature or at the posterior wall. Histological examination showed that 13 patients had early gastric cancer, seven had advanced cancer, and two had malignant GISTs. Lymph node metastasis was observed in two patients. The comparative study revealed that there were no significant differences in the operation time and the length of hospital stay. There was no anastomotic leakage or intraabdominal abscess, and no operative deaths. Other complications were anastomotic stricture in 2 patients, pouch bleeding in one, pouch ulcer in one, and delayed emptying in two patients. No other symptoms, including dumping or reflux esophagitis, were recognized in any of the patients. CONCLUSION: Proximal gastrectomy reconstructed with jejunal pouch interposition was a safe procedure and led to a better quality of life, as judged from the functional studies in our patients. However, long term follow-up results of quality of life and survival will be necessary to confirm the superiority of this procedure.

Keyword

Stomach neoplasm; Proximal gastrectomy; Jejunal pouch interposition

MeSH Terms

Abscess
Anastomotic Leak
Constriction, Pathologic
Esophagitis, Peptic
Esophagus
Female
Follow-Up Studies
Gastrectomy*
Gastric Stump
Hemorrhage
Humans
Length of Stay
Lymph Nodes
Male
Neoplasm Metastasis
Quality of Life
Stomach Neoplasms
Ulcer
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