Reconstruction With Jejunal Pouch & Improvement In Nutritional Condition - Brief Article

Nutrition Research Newsletter, August, 2001 by T. Nozoe, H. Anai, K. Sugimachi

Total gastrectomy is the most common surgical procedure for patients with gastric cancer. Although the postoperative prognosis has been improved by the aggressive surgical treatments available, postoperative symptoms including heartburn with the regurgitant esophagitis and nutritional disorder have become serious disturbances for these patients. In patients treated with total gastrectomy, reconstruction with Hunt-Lawrence-Rodino pouch and Roux-en-Y is a modified standard procedure of esophagojejunostomy. This substitute has been called the J-pouch and has been emphasized as having such advantages as the production of the pseudopyloric function to slow the progress of ingested food from a reservoir into the small intestine and reduce the distressing symptoms of the dumping system, and to provide a reservoir for digestion and absorption, therefore lessening the requirement for frequent meals. The current study investigated the occurrence of heartburn, body weight gain, and prognostic nutritional index to evaluate objectively the quality of life of the patients treated by total gastrectomy and reconstruction with Roux-en-Y and a jejunal pouch.

Sixteen patients with gastric cancer treated by total gastrectomy and reconstruction with simple Roux-en-Y from January 1993 to December 1996 (Group RY) and 14 patients treated with a total gastrectomy and reconstruction with Roux-en-Y and a jejunal pouch from January 1997 to December 1998 were investigated. Patients were interviewed about heartburn and changes in body weight on a monthly basis. The prognostic nutritional index (PN I) was used to determine the nutritional condition of the patients.

Clinicopathological features were investigated, and there was no significant difference observed between the two groups. The average operative time in group RYJ was longer than that in group RY. The estimated blood loss in group RYJ was also larger than that in group RY. One patient in group RY had anastomotic leakage. Heartburn was complained of by 1 patient in group RYJ. There was no significant difference in the values of the preoperative body weight between group RYJ and group RY. The body weight ratio at 1 year after operation in group RYJ was significantly higher than that in group RY. However, there was no significant difference in the values of the body weight ratio at 2 years after operation. The mean value of serum albumin at 1 year after operation in group RYJ was significantly higher than in group RY. The PNI scores for patients in group RYJ at 1 and 3 months were significantly higher than that in the patients treated with simple RY

These data suggest that the reconstruction using a jejunal pouch in total gastrectomy can contribute to an early improvement of the nutritional condition after total gastrectomy for patients with gastric cancer.

T. Nozoe, H. Anai, K. Sugimachi. Usefulness of reconstruction with jejunal pouch in total gastrectomy for gastric cancer in early improvement of nutritional condition. Am J Surg 181:274-278 (2001) [Correspondence: Tadahiro Nozoe. Phone: +81-092-642-5466. Fax: +81-092-642-5482. E-mail: nozoet@surg2.med.kyushu-u.ac.jp].