Reconstructive Procedures for Total or Proximal Gastrectomy and Postoperative Reflux
A total of 325 patients with gastric cancer were subjected to total gastrectomy and proximal gastrectomy at our clinic during the 20-years period from 1965 to 1984. The incidence of postoperative esophagitis was as high as 24% in the 106 cases treated during the first 9 years. In 1974, therefore, we started to employ the following reconstructive procedures for the prevention of this complication: (1) procedures following total gastrectomy: (a) Roux-en Y, in which a distance of 40 cm was taken between anastomoses (esophagus-jejunojejunostomy) and (b) jejunal interposition between the esophagus and duodenum, in which a jejunal segment 40 cm long was used; and (2) procedure following proximal gastrectomy: jejunal interposition between the esophagus and stomach, in which a jejunal segment of appropriate length was used so that the distance between anastomoses came to 40 cm. As a consequence, the incidence of postoperative endoscopic esophagitis was reduced to 3.7%. However, 13% of the patients who received total gastrectomy and 18% of those who received proximal gastrectomy still complained of reflux symptoms. These incidences were higher than that determined after subtotal gastrectomy.
KeywordsTotal Gastrectomy Reconstructive Procedure Reflux Symptom Proximal Gastrectomy Bile Reflux
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