Abstract:

The most prominent and severe complication after a total gastrectomy is severe reflux esophagitis. We have developed a procedure involving jejunal pouch-esophagostomy to avoid such postoperative reflux. The novel procedure reported here initially involves folding a jejunal segment of approximately 35 cm in length. A side-to-side jejuno-jejunostomy at the anti-mesenteric side was then affected using a 100-mm linear stapler. This resulted in a jejunal pouch, 10 cm in length, and a 7-cm apical section of unstapled jejunal loop. Finally, an esophago-jejuno end-to-side anastomosis (pouch-esophagostomy) was formed at the right anterior wall of the apical bridge using a circular stapler. We have therefore introduced a "partial posterior fundoplication"-like wrapping technique to the standard gastrectomy using the apical bridge of the jejunal pouch. Only a little postoperative reflux was revealed by barium meal testing - even in the Trendelenburg's position - in patients treated with the described anti-reflux anastomosis procedure. Jejunal pouch reconstruction with partial posterior wrapping is a useful procedural addition for minimizing reflux esophagitis following a total gastrectomy.

Authors:

Michiya Kobayashi, M.D., Ph.D., Kochi Medical School, Nankoku, Japan; Ken Okamoto, M.D.; Kochi Medical School, Nankoku, Japan; Takehiro Okabyashi, M.D., Ph.D., Kochi Medical School, Nankoku, Japan, Toyokazu Akimori, M.D., Kochi Medical School, Nankoku, Japan, Tsutomu Namikawa, M.D., Ph.D., Kochi Medical School, Nankoku, Japan; Junichi Sakamoto, M.D., Ph.D., Nagoya University Graduate School of Medicine, Nagoya, Japan; Kazuhiro Hanazaki, M.D., Ph.D., Kochi Medical School, Nankoku, Japan

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