Post-Gastrectomy Reconstruction


Authors: T. Malý 1;  P. Zonča 2;  Č. Neoral 1;  A. Jurytko 2
Authors‘ workplace: 1. chirurgická klinika, LF UP a FN Olomouc, přednosta: Doc. MUDr. Č. Neoral, CSc. 1;  Zentrum für Viszeral und Minimal Invasive Chirurgie, Wesseling, Köln am Rhein, Nordrhein-Westfallen Germany, přednosta: Prof. Dr. med. C. A. Jacobi 2
Published in: Rozhl. Chir., 2008, roč. 87, č. 7, s. 367-375.
Category: Monothematic special - Original

Overview

Aim:
Authors present review of current opinion in reconstruction of gastrointestinal tract after gastrectomy, in pouch benefit and benefit of retaining of the duodenum in food transit, and the importance of antireflux procedure.

Method:
Authors searched the Medline database for current trials regarding the reconstruction of gastrointestinal tract after gastrectomy. The key words were gastrectomy, reconstruction, and upper GI. The search was limited to those languages: English, German, and Czech. The authors identified 41 trials altogether. The trials were analysed regarding the pouch benefit and the retaining of duodenum in food transit. The comparison was done.

Conclusion:
The trials’ results are not homogenous. Many patients are not possible to be evaluated because of the tumor recurrence with weight loss and other symptoms. There is no ideal reconstruction according to the trials. Patients can benefit from the reconstruction retaining the duodenum in food transit and with pouch creation. The retained duodenum in food transit is anormal stage from the anatomical and physiological view. In the case that pouch allows the proportional evacuation of food, the retaining of duodenum is advantageous. The pouch combined with antireflux procedure has a potential to improve life duality from longer perspective. On the other side, some authors present opinion that the reconstruction with pouch is too complicated with worse patient perioperative tolerance and its benefit is minimal. There is a very small number of prospective randomized trials which present a very small number of patients without statistical significance. It is important to perform a larger prospective randomized trial.

Key words:
gastrectomy – reconstruction – upper GI


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