Roux-en Y with J pouch versus simple roux-en Y reconstruction after total gastrectomy for gastric cancer functional assessment and quality of life

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Abstract

Background
Replacement of the reservoir function of the stomach after total gastrectomy is of particular importance. And several types of gastric substitutes have been suggested. The most widely accepted is the Hunt-Lawrence- Rodino or Jejunal pouch.
Aim and objectives
To compare the nutritional, functional outcomes and quality life of a Jejunal pouch reconstruction to the simple Roux -en-Y esophago jejunostomy in patients who had total gastrectomy due to cancer.
Subjects and methods
40 patients underwent total gastrectomy and reconstruction at the upper GIT surgery unit of the Department of Surgery of the University Medical School of Ain shams between august 2020 and October 2022. Patients divided into two groups, group (A) 20 patients reconstructed by simple roux -en – y esophagojejunostomy. Group (B) 20 patients reconstructed by roux - en – y esophagojejunostomy with oral type jejunal pouch. Both groups were compared regarding anthropometeric, nutritional and laboratory values at preoperative, 3 and 6 months p o, also early postoperative complications, post gastrectomy and reflux symptoms and patient's QOLI using Eypasch questionnaire at 6 month p o.
Results
No significant difference regarding morbidity or mortality associated with pouch reconstruction (-value >0.05) .also no significance regarding body weight, BMI at 3 and 6 months p o. the pouch group was associated with a lower incidence of dumping, diarrhea and reflux symptoms (-value <0.05)., also a better food intake, and better quality of life parameters at 6 months post -operative (-value <0.05).
Conclusion
In a 6-month follow-up after total gastrectomy, pouch reconstruction was superior to Roux-en-Y esophagojejunostomy in terms of p o food intake, incidence of dumping, diarrhoea, and reflux symptoms, as well as quality of life.

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