Jejunal pouch reconstruction after total gastrectomy. A long term evaluation

The best type of digestive reconstruction following total gastrectomy (TG) for gastric malignancy (GM) is still controversial. The Roux-en-Y (RY) remains the most widely used method; however malnutrition, adverse symptoms and derangement in quality of life are frequently observed. The modification of the standard RY by jejunal Hunt-Lawrence-Rodino pouch or J-pouch (JP) seems to reduce the effects of gastric loss. In order to improve the advantages of the JP method we adopted a modification consisting in the construction of a second pouch in the distal part of the Roux limb. Patients and methods: Twenty-threc patients with GM who had undergone, between 1990 and 1995, D1-D2 TG and double-pouch (DP) reconstruction were assessed in order to determine the advantages of (a) reservoir function; (b) RY symptoms; (c) quality of life. Seven patients similar for age, primary disease and surgical treatment except for a simple RY reconstruction were compared. The patients were evaluated for at least 6 months after operation with a mean follow-up of 37.8_+ 13.7 months. Follow-up studies consisted in endoscopic examination, blood count, serum proteins (SP), actual body weight (BW) and symptoms (Cushieri's scoring (CS)). Results: No operative deaths were observed. There were 18 survivors without evidence of recurrence. Oesophageal mucosal changes (hyperemia, erosions) were documented similarly in both groups (39% vs 43%). A gain in BW was recorded in 83% of DP group compared with 71% of RY groups (NS). Analysis of CS revealed a score of 4.4_+ 1 in DP group with a significant difference with that 13.6_+22.3 (P<0.01) of RY group. Because of the higher quality of life observed in DP group, the reconstruction by a double-pouch procedure can be recommended.