Early dumping syndrome and reflux esophagitis prevention with pouch reconstruction

The clinical effectiveness of the method by establishing a proximal jejunum pouch after laparoscopic total gastrectomy: A propensity score-based analysis

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.

[Functional results of digestive tract reconstruction after gastrectomy]

AIM

To substantiate and to prove the advantages of the new method of gastroplasty in comparison with traditional loop reconstruction of digestive tract after gastrectomy.

MATERIAL AND METHODS

It was performed prospective comparative study of surgical treatment of 431 patients with gastric cancer who underwent gastrectomy with different variants of digestive tract reconstruction. The main group (146 patients) consisted of patients in whom original technique including establishment of food reservoir in initial jejunal part during reconstruction was applied. The control group consisted of patients with traditional loop reconstruction of the digestive tract (285 patients).

RESULTS

Early dumping syndrome (within 1 year) was diagnosed in 9 (13.2%) patients of the main group and 16 (21.6%) patients of the control group. Mild and moderate degrees of this syndrome were observed in 7 (77.8%) and 10 (62.5%), 2 (22.2%) and 4 (25.0%) patients in the main and control groups respectively. Severe dumping syndrome occurred in 2 (12.5%) patients only in the control group. Late dumping syndrome was revealed in 7 (10.3%) and 11 (14.9%) patients, respectively. Body mass index was 18.7±0.8 and 17.4±0.6 (p<0.05), respectively. After 2 years early dumping syndrome was diagnosed in 6 (14.3%) and 10 (21.3%) patients, mild degree in 5 (83.3%) and 5 (50.0%) patients; moderate degree in 1 (16.7%) and 3 (30.0%). Severe dumping syndrome was confirmed in 2 (20.0%) patients from the control group. Late dumping syndrome occurred in 4 (9.5%) and 7 (14.9%), respectively. Body mass index was 21.2±0.7 and 19.0±0.9 (p<0.05), respectively. After 3 years, early dumping syndrome in mild form was diagnosed in 2 (10.5%) cases and late syndromy in 1 (5.3%) patient of the main group. There were 5 (21.7%) patients with the syndrome in the control group including mild and moderate severity in 3 (60.0%) and 2 (40.0%) patients respectively. Late dumping syndrome occurred in 3 (13.0%) patients. Body mass index was 21.9±1.0 and 19.7±0.6 respectively.

CONCLUSION

Food reservoir in the initial part of jejunum after gastrectomy creates better conditions for the normalization of metabolic exchange resulting early functional digestive adaptation, especially in long-term period.

Reconstruction with Jejunal Pouch after Gastrectomy for Gastric Cancer

The construction of a gastric substitute pouch after gastrectomy for gastric cancer has been proposed to help ameliorate postprandial symptoms and nutritional performance. Adequate reconstruction after gastrectomy is an important issue, because postoperative patient quality of life (QOL) primarily depends on the reconstruction method. To this end, jejunal pouch (JP) reconstructions were developed to improve the patient's eating capacity and QOL by creating large reservoirs with improved reflux barriers to prevent esophagitis and residual gastritis. It is important that such reconstructions also preserve blood and extrinsic neural integrity for maintaining pouch function, because JP motility is associated directly with QOL. Some problems remain to be resolved with the JP reconstructions method including gastrointestinal motility, which plays a major role in food transfer, digestion, and absorption of nutrients. Further studies including basic research and larger prospective randomized control trials are also needed to obtain definitive results. With persistent innovations in surgical techniques, JP after gastrectomy could become a safe and preferable reconstructive modality to improve patient QOL after gastrectomy.

A safe anastomotic technique of using the transorally inserted anvil (OrVil) in Roux-en-Y reconstruction after laparoscopy-assisted total gastrectomy for proximal malignant tumors of the stomach

Background

To explore the safety and feasibility of the transorally inserted anvil (OrVil™) in laparoscopy-assisted total gastrectomy for gastric cancer.

Methods

From December 2010 to June 2011, a total of 28 patients underwent laparoscopy-assisted total gastrectomy with a Roux-en-Y-esophagojejunostomy anastomosis with OrVil™. Perioperative treatments, intraoperative data, postoperative complications and hospital length of stay were evaluated.

Results

There were no conversions to the open gastrectomy. The mean operation time was 143 minutes and the mean blood loss was 70 ml. Patients resumed an oral liquid diet on postoperative days 4 to 5. Two patients (7%) who suffered postoperative aspiration pneumonia were cured by conservative treatment. The median hospital length of stay was 9.6 days (8 to 11 days), with no inhospital mortalities. The median follow-up time was 14.8 months (12 to 18 months), and postoperative endoscopic examination revealed no anastomosis stenosis in patients who had dysphagia.

Conclusion

The use of the OrVil™ is technically feasible and relatively safe for Roux-en-Y reconstruction after laparoscopy-assisted total gastrectomy.