Distal pouch reconstruction with transverse jejunoplasty after experimental gastrectomy.

Purpose: Various reconstruction methods with or without reservoir formation after total gastrectomy have been established. Transverse intestinoplasty has benefits as a functional peristalsis modification in rectal resections. In this study, we evaluate a distal pouch combined with a transverse jejunoplasty compared to standard Roux-en-Y reconstruction.

Methods: Total gastrectomy was performed on 23 pigs randomly assigned to 3 reconstruction groups-group 1 (n = 7): esophagojejunostomy without a pouch, group 2 (n = 8): esophagojejunostomy with a distal pouch, and group 3 (n = 8): distal pouch with a transverse jejunoplasty. Seven days postoperatively, weight was measured, and X-ray examinations were conducted for 1 h after oral contrast medium application. Blood glucose levels after oral glucose intake and the volume of the pouch loop were evaluated.

Results: Upper jejunal passage was delayed and the mean volume of the jejunal loop increased by pouch formation compared to controls (p < 0.05). Body weight was the best for the pouch group with jejunoplasty (-1.9 ± 0.8% vs. pouch alone -3.3 ± 2.4% vs. no pouch -7.5 ± 2.1%, p < 0.05).

Conclusions: The distal jejunal pouch after total gastrectomy offers advantages with respect to bowel passage and postoperative nutrition status compared to standard Roux-en-Y reconstruction. The combination of a distal pouch and transverse jejunoplasty may provide additional functional benefits.