Post-Gastrectomy Reconstruction

Česká verzia

Authors: T. Malý ¹; P. Zonča ²; Č. Neoral ¹; A. Jurytko ²
Authors place of work: 1. chirurgická klinika, LF UP a FN Olomouc, přednosta: Doc. MUDr. Č. Neoral, CSc. ¹; Zentrum für Viszeral und Minimal Invasive Chirurgie, Wesseling, Köln am Rhein, Nordrhein-Westfallen Germany, přednosta: Prof. Dr. med. C. A. Jacobi ²
Published in the journal: Rozhl. Chir., 2008, roč. 87, č. 7, s. 367-375.
Category: Monothematic special - Original

Summary

Aim:
Authors present review of current opinion in reconstruction of gastrointestinal tract after gastrectomy, in pouch benefit and benefit of retaining of the duodenum in food transit, and the importance of antireflux procedure.

Method:
Authors searched the Medline database for current trials regarding the reconstruction of gastrointestinal tract after gastrectomy. The key words were gastrectomy, reconstruction, and upper GI. The search was limited to those languages: English, German, and Czech. The authors identified 41 trials altogether. The trials were analysed regarding the pouch benefit and the retaining of duodenum in food transit. The comparison was done.

Conclusion:
The trials’ results are not homogenous. Many patients are not possible to be evaluated because of the tumor recurrence with weight loss and other symptoms. There is no ideal reconstruction according to the trials. Patients can benefit from the reconstruction retaining the duodenum in food transit and with pouch creation. The retained duodenum in food transit is anormal stage from the anatomical and physiological view. In the case that pouch allows the proportional evacuation of food, the retaining of duodenum is advantageous. The pouch combined with antireflux procedure has a potential to improve life duality from longer perspective. On the other side, some authors present opinion that the reconstruction with pouch is too complicated with worse patient perioperative tolerance and its benefit is minimal. There is a very small number of prospective randomized trials which present a very small number of patients without statistical significance. It is important to perform a larger prospective randomized trial.

Key words:
gastrectomy – reconstruction – upper GI

Zdroje

1. Connor, P. S. Report of a case of complete resection of the stomach. Med. News, 45: 1884, 578.

2. Schlatter, C. Über Ernahrung und Verdauung nach vollstandiger Entfernung des Magens und Oesophagoenterostomie beim Menschen. Beitrag zur klinischen Chirurgie, 19, 1897, 757.

3. Roux, C. De la gastro-enterostomie. Etude basee sur les operations pratiques du 21 juin 1888 au 1 er Septembre 1896. Rev. Gynecol. Chir. Abdominale, 1: 1897, 67–122.

4. Hoffman, V. Eine Metode des plastischen Magenersatzes. Zentralbl. Chir., 49: 1922, 1477.

5. Horsley, J. S. Operative surgery, vol. 2. Mosby, St Louis, 1940, 1032.

6. Graham, R. R. Technique for total gastrectomy. Surgery, 8: 1940, 257–264

7. Hunt, C. J. Construction of a food pouch from segment of jejunum as substitute for stomach in total gastrectomy (abstract). Arch. Surg., 64: 1952, 601.

8. Lawrence, W. Reservoir reconstruction after total gastrectomy: an instructive case. Ann. Surg., 155: 1962, 191.

9. Largiader, F., Sauberli, H. Reconstruction nach Gastrektomie, insbesondere mit Jejunumersatzmagen. Helv. Chir. Acta, 39, 1972, 883–886.

10. Mandl, F. Operative Versuche zur Behandlung der Sturzentleerung nach totaler Magenresektion. Chirurg, 26: 1955, 403–404.

11. Nakayama, K. New reconstructive Metod after excision of lower esophagus and cardial portion of stomach with anastomoses combined with antrectomy. Surgery, 54, 1963, 281.

12. Paulino, F., Roselli, A. Carcinoma of the stokách. Curr. Probl. Surg., 1973.

13. Nadrowski L. Is a distal jejunojejunal pouch nutritionally ideal in total gastrectomy? Am. J. Surg., 2003, Apr, 185(4): 349–353.

14. Doherty, C. Restoration of the alimentary tract using autosuture staples. Am. J. Surg., 131: 1976, 629–633.

15. Lygidakis, N. J. 1981, Total gastrectomy for gastric carcinoma Koussidis, A., Apsokardou-Koussidou, M., 1990, Fragment of alkaline gastritis and recurrent ulcer following Roux-en-Y gastrectomy and construction of a Rumph‘s antireflux valve. Zentralbl. Chir., 115, 95-102

16. Seo, S. Stomach resection transplanting jejunum. J. Jpn. Clin. Surg. Soc., 42: 1941, 1004.

17. Hays, R. P. Anatomic and physiologic reconstruction following total gastrectomy by the use of the jejunal pouch. Surg. forum Clin. Congr. Amer. Coll. Surg., WB Sauders Co, Philadephia: 1953, 291.

18. Gutgeman, A., Schreiber, H. W. Erfahrungen mit der totalen Gastrektomie. Langenbecks Arch. Klin. Chir., 303, 1963, 73.

19. Poth, E. J., Smith, L. B. Gastric pouch, their evaluation. Am. J. Surg., 112: 1966, 721–727.

20. Kieninger, G., Koslowski, I., Durst, J., et al. Clinical experience with a new method of gastric replacement following total gastrectomy. World J. Surg., 3, 1979, 737–743.

21. Morii, Y., Arita, T., Shimoda, K. a kol. Jejunal interposition to prezent postgastrectomy syndromes. Br. J. Surg., 87, 2000, 1576–1579.

22. Cushieri, A. Long-term evaluation of a reservoir jejunal interposition with an isoperistaltic konduit in the management of patients with the small stomach syndrome. Br. J. Surg., 11: 1982, 127–139.

23. Nakane, Q., Okumura, S., Akehira, K., et al. Jejunal pouch reconstruction after total gastrectomy for cancer. A randomized controlled trial. Ann. Surg., 222: 1995, 27–35.

24. Schwarz, A., Beger, H. G. Veranderungen im gastrointestinalen Hormonhaushalt nach Gastrektomie: Was ist klinisch relevant? Chir. Gastroenterol., 16 (Suppl 2), 2000, 25–30.

25. State, D., Barclay, T., Kelly, W. D. Total gastrectomy with utilization of a segment of transverse colon to replace the excised stomach. Ann. Surg., 134: 1951, 1035.

26. Hunnicutt, A. J. Replacing stomach after total gastrectomy with right ileocolon. Arch. Surg., 65: 1952, 1–11.

27. Lee, M. C. Transposition of a colon segment as a gastric reservoir after total gastrectomy as a gastric reservoir after total gastrectomy. Surg. Gyn. Obst., 92: 1951, 456–465.

28. Lygidakis, N. J. Long-term results of a new method of reconstruction for continuity of the alimentary tract after total gastrectomy. Surg. Gyn. Obstetr, 158: 1984, 335–338

29. Largiader, F., Sauberli, H. Rekonstrucktion nach Gastrektomie, insbesondere mit Jejunumersatzmagen. Helv. Chir. Acta, 39, 1972, 883–886.

30. Troidl, H., Kusche, J., Vestweber, K. H., et al. Pouch versus esophagojejunostomy after total gastrectomy: A randomized clinical trial. World J. Surg., 11: 1987, 699–712

31. Berglund, B., Liedman, B., Olbe, L., a kol. Reservoir function after subtotal or total gastrectomy with or without gastric substitute. Eur. J. Surg., 157: 1991, 201–204.

32. Iivonen, M., Matikainen, M., Nordback, I. Jejunal pouch reconstruction diminishes postoperative symptoms after total gastrectomy. Dig. Surg., 14: 1997, 260–266.

33. Tanaka, T., Kusonoki, M., Fujiwara, Y, Nakagawa, K., Utsunomiya, J. Jejunal pouch length influences metabolism after total gastrectomy. Hepatogastroenterology, 44: 1997, 891–896.

34. Hoksch, B., Zippel, K., Sandrock, D., et al. Does the pouch jodid food transit after gastrectomy? Langenbecks Arch. Chir. Suppl. Kongressbd., 115: 1998, 1377–1379.

35. Schwarz, A., Beger, H. G. Veranderungen im gastrointestinalen Hormonhaushalt nach Gastrektomie: Was ist klinisch relevant? Chir. Gastroenterol., 16 (Suppl 2), 2000, 25–30.

36. Fujiwara, Q., Kusunoki, M., Nakagawa, K., et al. Evaluation of J-pouch reconstruction after total gastrectomy: rho-double tract vs. J-pouch double tract. Dig. Surg., 17: 2000, 475–482.

37. Schuhmacher, C., Bottcher, K. A., Siewert, J. R. Instestinale Pouches: Magenersatz. Chirurg, 70: 1999, 520–529.

38. Tanaka, T., Kusonoki, M., Fujiwara, Y, Nakagawa, K., Utsunomiya, J. Jejunal pouch length influences metabolism after total gastrectomy. Hepatogastroenterology, 44: 1997, 891–896.

39. Zonca, P., Maly, T., Herokova, J., Kvetensky, M., Halva, Z. Reconstruction after total gastrectomy. Bratisl. Lek. Listy, 2002: 103(11): 414–417

40. Bozzetti, F., Bonfanti, G., Castellani, R., et al. Comparing reconstruction with Roux-en-Y to a pouch following total gastrectomy. J. Am. Coll. Surg., 183: 1996, 243–248.

41. Liedman, B., Bosaeus, I., Hugossson, I., et al. Long-term beneficia effects of a gastric reservoir on weight control after total gastrectomy. A study of potential mechanisms. Br. J. Surg., 85: 1998, 542–547.

42. Zelnick, R., Auguste, L. J., Wise, L. Nutritional effects of postgastrectomy reconstruction: a clinical evaluation. J. Surg. Oncol., 40, 1989, 20–21.

43. Cushieri, A. Jejunal pouch reconstruction after total gastrectomy for cancer: experience in 29 patients. Br. J. Surg., 77: 1990, 421–424.

44. Miholic, J., Meyer, H. J., Balks, J., et al. Effect of reconstruction method on nutritional status after gastrectomy. Comparison of Roux-Y esophagojejunostomy and jejunum interposition. Chirurg, 62: 1991, 300–305.

45. Schwarz, A., Beger H. B. Gastric substitute after total gastrectomy clinical relevance for reconstruction techniques. Langenbecks Arch. Surg., 383: 1998, 484–491.

46. Aujeský, R., Neoral, Č., Koranda, P. Restoration of the Passage after Total Gastrectomy. Rozhl. Chir., 77, 1998, č. 1, s. 42–44.

47. Nakane, Q., Okumura, S., Akehira, K., et al. Jejunal pouch reconstruction after total gastrectomy for cancer. A randomized controlled trial. Ann. Surg., 222: 1995, 27–35.

48. Fuchs, K. H., Thiede, A., Engemann, R., et al. Reconstruction of the food passage after total gastrectomy: randomized trial. World J. Surg., 19: 1995, 698–705.

49. De Almeida, A. C., dos Santos, N. M., Aldeia, F. J. Total gastrectomy for cancer: is reconstruction or a gastric replacement reservoir essentials? World J. Surg., 18: 1994, 883–888.

50. Heimbucher, J., Fuchs, K. H., Freys, S. M. et al. Motility in the Hunt-Lawrence pouch after total gastrectomy. Am. J. Surg., 168: 1994, 622–626.

51. Roder, J. D., Herschbach, P., Henrich, G., et al. The quality of life after total gastrectomy for stomach carcinoma. Esophagojejunal plication with pouch versus esophagojejunostomy without pouch. Dtsch. Med. Wochenschr., 117: 1992, 241–247.

52. Ikeda, M., Ueda, T., Shiba, T. Reconstruction after total gastrectomy by the interposition of a double jejunal pouch using a double stapling technique. Br. J. Surg., 85: 1998, 398–404.

53. Morii, Y., Arita, T., Shimoda, K., a kol. Jejunal interposition to present postgastrectomy syndromes. Br. J. Surg., 87, 2000, 1576–1579.