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Objective:To evaluate the safety and efficiency of a modified double-tract reconstruction procedure─proximal gastrectomy with piggyback interposed jejunal single-channel reconstruction (PJIR-STR) for early SiewertⅡ adenocarcinoma of esophagogastric junction (AEG).Method:Data of 8 SiewertⅡ AEG patients at Shanxi Tumor Hospital and undergoing PJIR-STR from May 2018 to Oct 2019 were retrospectively analyzed. The gastroesophageal reflux disease questionnaire (GerdQ) was used to score the patients at 3, 6, 12, and 18 months after surgery. The severity of postoperative reflux esophagitis was assessed by gastroscopy at 3, 6 months after surgery, using the Los Angeles Classification criteria.Result:All patients recovered well after surgery without serious complications. No obvious gastroesophageal reflux was observed in all patients at different periods (All of the GerdQ scores were <8 points.) The results of gastroscopy showed that 1 patient was diagnosed as grade B reflux esophagitis at 3, 6 months after surgery, which was responsive to conservative treatment, and the other 7 patients had no grade B or above reflux esophagitis.Conclusion:PJIR-STR is a feasible, safe reconstruction with excellent efficiency of dual anti-reflux for the SiewertⅡ AEG.
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Objective To investigate and compare the effects of jejunal interposition and Roux-en-Y surgery after total gastrectomy. Methods The clinical data of 41 patients with gastric cancer who underwent total gastrectomy in our hospital from June 2013 to June 2016 were retrospectively analyzed.According to the different ways of reconstruction of digestive tract,the patients were divided into observation group and control group.Patients of the observation group were with jejunal interposition surgery,while patients of the control group were trea-ted with Roux-en-Y surgery,and the effects of the two groups were compared and analyzed.Results There was no significant difference be-tween the two groups in the time of reconstruction,length of hospital stay and the incidence of complications(P>0.05).One year after sur-gery,incidence of complications,albumin,total health score,fatigue score,and disgust score of the observation group were significantly better than those of the control group with statistically significant difference(P<0.05).There was no significant difference between the two groups in survival rate,hemoglobin,total protein,weight changes(P>0.05).Conclusion For patients with total gastrectomy,jejunal interposition and Roux-en-Y surgery had similar effect.But in terms of the long-term effect,jejunal interposition can reduce complications and improve lev-el of nutrition and quality of life.
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Objective: To evaluate the short-term efficacy of R-type jejunal interposition and esophagojejunostomy by delta-shaped anastomosis after totally laparoscopic radical gastrectomy for gastric stump carcinoma. Methods:Data on 10 patients with gas-tric stump cancer were analyzed retrospectively from January 2013 to August 2014. All the patients received R-type jejunal interposi-tion and esophagojejunostomy by delta-shaped anastomosis after totally laparoscopic radical gastrectomy for gastric stump carcinoma (laparoscope group) in the Lanzhou General Hospital of the Lanzhou Military Area. Laparotomy was performed on 18 cases that com-prised the control group (laparotomy group). The intraoperative and postoperative indicators between these two groups were then com-pared. All the patients were followed-up from 14 to 21 months after the operations. Results:The operations were successfully carried out in all 10 patients (laparoscope group), without performing open operation. The mean operative times, volumes of the intraoperative blood loss, numbers of dissected lymph nodes, frequencies of leaving the bed, days marking the first liquid diet intake, days marking the recovery of gastrointestinal function, and days of hospitalization of the laparoscope group and the laparotomy group were (210.0 ± 30.9) min and (283.9 ± 50.9) min, (90.0 ± 26.7) mL and (277.8 ± 79.1) mL, (19.0 ± 3.6) and (18.8 ± 3.7), (17.3 ± 3.6) h and (75.8 ± 15.7) h, (1.6 ± 0.4) d and (5.7 ± 1.3) d, (3.0 ± 0.8) d and (7.2 ± 1.3) d, and (7.6 ± 1.2) d and (20.8 ± 3.9) d, respectively. Anastomotic stricture, reflux esophagitis, bleeding, leakage, dumping syndrome, or intestinal obstruction was not detected in the laparoscope group. There was no perioperative death. All of the cases exhibited good nutrition situation, and no choking or esophagus burning was reported. Conclusion:R-type jejunal interposition and esophagojejunostomy by delta-shaped anastomosis after totally laparoscopic radical gastrectomy is safe and feasible. The operation can improve the quality of life of patients and induce positive short-term therapeutic effects. Laparo-scopic-assisted radical gastrectomy for gastric stump cancer has the same effect as laparotomy.
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Objective To explore the application value of gastrointestinal reconstruction by continuous jejunum interposition after total gastrectomy.Methods A retrospective analysis in March 2006 to March 2012 was performed in 60 patients with gastric underwent continuous jejunal interposition after total gastrectomy.Results There were no operation death and anastomotic fistula.Follow-up for 12-24 months,some patients had mild reflux esophagitis,generation of gastric capacity of more than 300 ml,emptying time of 30-100 min.The quality of life was improved after operation.Conclusions Continuous jejunal interposition pouch is safe and reliable,with satisfactory effect of digestive tract reconstruction.
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Objective To explore the ideal reconstruction after total gastrectomy.Methods Following-up information on one postoperation year of 62 cases underwent continuous jejunal interposition pouch(CJIP)recon- struction and 60 cases of Roux-en-Y pouch(RYP)was compared.Results Although no statistical difference was found in nutritional status(body weight and serum nutritional paramerers)between the two groups,frequency of meals of CJIP was less than that of Roux-en-Y.The quantity of every meal and pouch enlargement of CJIP were ob- viously larger than those of RYP group.There were 9 cases of digestive fluid reflux syndrome,8 cases of dumping syndrome in RYP group simultaneously.Conclusion CJIP demonstrated no substantial nutritional advangate to RYP,but it still was the prefered type of reconstruction,because of its less postprandial disturbance than that of RYP.
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PURPOSE: A proximal gastrectomy is performed for gastric cancer in the upper part of the stomach to preserve the function of the stomach after surgery. An esophagogastrostomy is one of the common reconstruction methods for a proximal gastrectomy, but this method results in a high incidence of reflux esophagitis. This study was undertaken to compare subjective and functional results between esophagogastrostomy and jejunal interposition reconstructions. MATERIALS AND METHODS: From June 1998 to December 2002, proximal gastrectomies were perfomed in 33 patients with tumors in the upper third of the stomach; 8 had reconstruction using jejunal interposition between the esophagus and the remnant stomach (JI group) while 25 had reconstruction using esophagogastrostomy (EG group). The postroperative courses of the patients were reviewed in terms of symptoms, weight changes, and endoscopic findings. RESULTS: The mean age of the patients was 59 years; 26 were men and 7 were women. There were no significant differences in general complications, operating times, or histologic features between the two groups. Fifty-two percent (52%) of the EG group complained of dysphagia, and 16% them experienced heartburn and acid belching. Twelve percent (12%) of the JI group complained of dysphagia, but heartburn and acid belching did not occur. Incidences of reflux esphagitis (36%) and balloon dilatation for anastomotic stricture (16%) were more common in the EG group than in the JI group (0% and 12%). CONCLUSION: To prevent or minimize complications, such as reflux esophagitis and postoperative symptoms, a proximal gastrectomy with a jejunal interposition is an alternative method as an organ-preserving surgical strategy to improve quality of life for patients.
Subject(s)
Female , Humans , Male , Constriction, Pathologic , Deglutition Disorders , Dilatation , Eructation , Esophagitis, Peptic , Esophagus , Gastrectomy , Gastric Stump , Heartburn , Incidence , Prospective Studies , Quality of Life , Stomach , Stomach NeoplasmsABSTRACT
PURPOSE: The aim of this study was to evaluate the short- term outcome of a pylorus-preserving proximal gastrectomy by comparing it with a jejunal interposition after a total gastrectomy in proximal gastric adenocarcinoma. MATENRIALS AND METHODS: For 22 patients (12 men and 10 women) who underwent a pylorus-preserving proximal gastrectomy, several clinical parameters were obtained from the medical records retrospectively. In this study, the data were collected between September 1993 and December 1999 at Chungnam National University Hospital, and the results were compared with those of 25 patients (17 men and 8 women) who underwent an isoperistaltic simple jejunal interposition. RESULTS: The average operative time in the pylorus-preserving proximal gastrectomy group (220 minutes) was shorter than that in the jejunal interposition group (243 minutes) (P<0.05). The hemoglobin and hematocrit levels were significantly higher in the pylorus-preserving proximal gastrectomy group at 2 years after the operation. The body weight ratio (postoperative body weight/preoparative body weight) in patients who had a pylorus-preserving proximal gastrectomy was significantly higher than that in patients with a jejunal interposition at 2 years after the operation. The jejunal interposition procedure had better outcomes in anastomotic site stricture, duration of hospital stay, and number of removed lymph nodes (P<0.05). CONCLUSION: We think that from the viewpoint of quality of life, a pylorus-preserving proximal gastrectomy, as well as a jejunal interposition, is a useful reconstruction method for early adenocarcinomas of the proximal stomach. However, stricture of the esophagogastrostomy site in the pylorus- preserving proximal gastrectomy is a common problem to be solved in the future.
Subject(s)
Humans , Male , Adenocarcinoma , Body Weight , Constriction, Pathologic , Gastrectomy , Hematocrit , Length of Stay , Lymph Nodes , Medical Records , Operative Time , Quality of Life , Retrospective Studies , StomachABSTRACT
PURPOSE: The aim of this study was to evaluate the short-term outcome of a jejunal interposition, by comparing it with a conventional Roux-en-Y gastrojejunostomy, after a total gastrectomy. MATENRIALS AND METHODS: For 28 patients (20 men and 8 women) with a gastric adenocarcinoma, who underwent an isoperistaltic simple jejunal interposition, weight, hemoglobin, hematocrit, serum protein and albumin, and cholesterol levels were checked before the operation and at 1 year and 2 years after the surgery. Also, endoscopy was performed to confirm reflux esophagitis. In this study, the data were collected between January 1993 and July 1999 at Chungnam National University Hospital, and the results were compared with those of the Roux-en-Y procedure. RESULTS: The body weights at 1 year and 2 years after the surgery had returned to 86.0% and 87.6% of the recent original body weight in the jejunal interposition (JI) group and to 90.8%, 87.0%, respectively in the Roux-en-Y (RY) group. The levels of hemoglobin (g/dl) were 13.3, 12.5, and 11.9 in the JI group, and 13.8, 12.6, and 12.1 in the RY group at the time of the operation and at 1 year, and 2 years after the surgery, respectively. The total serum protein (g/dl) levels were 7.1, 7.2, and 7.5 in the JI group and 7.1, 7.0, and 7.2 in the RY gropu at the time of the operation and at 1 year and 2 years after the surgery, respectively. The serum albumin (g/dl) levels were 4.2, 4.1, and 4.2 in the JI group and 4.2, 4.2, and 4.2 in the RY group at the time of the operation and at 1 year, and 2 years after the surgery, respectively. The total serum cholesterol (mg/dl) levels were 186.5, 174, and 164 in the JI group and 213.7, 171.1, and 141.0 in the RY group at the time of the operation and at 1 year and 2 years after the surgery, respectively. The endoscopic finding showed that reflux esophagitis occurred in 7.1% of the patients in the JI group and in 3.5% in the RY group. CONCLUSION: We think that from the view point of quality of life, a jejunal interposition, as well as a Roux-en-Y procedure, is a useful reconstruction methods for a total gastrectomy.
Subject(s)
Humans , Male , Adenocarcinoma , Body Weight , Cholesterol , Endoscopy , Esophagitis, Peptic , Gastrectomy , Gastric Bypass , Hematocrit , Quality of Life , Serum AlbuminABSTRACT
Purpose: To evaluate the therapeutic effect of the jejunal interposition reconstruction SS and P type after total gastrectomy in patients with gastric carcinoma. Methods: 31 cases with gastric carcinoma operated on from June, 1990 - Octuber, 2000 were retrospectively analyzed. After total gastrectomy 16 patients were operated by jejunal interposition reconstruction SS type and 15 a jejunal interposition reconstruction P type. The clinic materials of the two types of jejunal interposition reconstruction were assessed by 6 months -5 years follow-up. Results: 30 -60 minutes and 80 - 120 minutes Ba emptying time of SS and P type were 62. 5%, 66. 7% and 37. 5%, 33. 3% respectively ; BLA were 73. 6 + 1. 1% and 74. 4 + 1. 3% , respectively; HB were 15 +1.3 and 15 +1.5; The Visick scoring of the 87. 7% patients with S type and the 86. 7% patients with P type was Ⅰ - Ⅱ grades. Reflux oesophagitis of the patients with S type was 12. 5%. Conclusions: The jejunal interposition reconstruction SS and P type after total gastrectomy are effective means to improve quality of life and to reduce complications after gastrectomy and to maintain the canal of the chyme through the duodenal tract.
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Objective To evaluate the therapeutic effect of the jejunal interposition reconstruction type Ⅰ and Ⅱ after total gastrectomy in patients with gastric carcinoma.Methods 31 cases of gastric carcinoma operated were retrospectively analyzed, 16 patients after total gastrectomy were reconstructed to have a jejunal interposition type Ⅰ and 15 a jejunal interposition reconstruction type Ⅱ. The clinic data of the two types jejunal interposition reconstruction were assessed during 6 months ～5 years follow-up. Results 30- 60 minutes and 80-120 minutes barium agent emptying time of type I and II were 62.5%,66.7% and 37.5%,33.3% respectively;normal diet regimen(4～6 meals/d)was recovered,plasma total protein 56～75g/L accounted for 74 2%(23/31),46～56g/L accounted for 25 8%(8/31).Hemoglobin 110～160g/L accounted for 38 7%(12/31) 96～105g/L accounted for 61 3%(19/31).Mean body weight was decreased by 3～5kg in all groups.9 cases recovered eight physical strength labor.The visick scoring of the 87 7% patients with type I and the 86 7% patients with type II was I-II grades. Reflux oesophagitis of the patients with type I was 12 5%. Conclusions The jejunal interposition reconstruction type Ⅰ and Ⅱ is suitable reconstruction after total gastrectomy to improve quality of life and to reduce complications and to maintain the canal of the chyme through the duodenal tract.