Symptomatic and objective assessment after total gastrectomy: A comparison of three methods of reconstruction of the digestive tract

No method for reconstructing the digestive tract following total gastrectomy is considered ideal. We made a retrospective, symptomatic and objective assessment of 49 patients who had undergone a curative total gastrectomy in the period 1974-1989 to evaluate the long-term results of the three methods we had used. Fourteen patients (28.5%) had had jejunal pouch interposition, 20 patients (41%) Nakayama’s β-anastomosis and 15 patients (30.5%) Roux-en-Y reconstruction. The frequency of symptoms, oesophagitis at the endoscopic examination, and nutritional status (body weight vs. ideal weight, haemoglobin and serum albumin values) were evaluated in each of the three groups. The mean follow-up was 38 months (range: 6-124 months). No statistically significant differences were seen among the three groups as far as nutritional status and frequency of symptoms were concerned: However, endoscopic findings showed that alkaline reflux oesophagitis was associated with ’-anastomosis reconstruction (35% vs. 7% after jejunal pouch interposition, and 6.5% after Roux-en-Y reconstruction: Partitioning x2'- P = 0.012). Our findings show that the long-term results after total gastrectomy of digestive reconstruction with jejunal pouch interposition and the Roux-en-Y procedure were not significantly different.