POUCH RECONSTRUCTION AFTER TOTAL GASTRECT OMY - CLINICAL OUTCOME AND RADIONUCLIDE TRANSIT INVESTIGATION

The formation of a pouch is a surgical procedure to restore the lost o f reservoir function after resection of the stomach. After total gastr ectomy the intestinal passage can be reconstructed by a jejunal pouch performing a Siewert/Peiper esophagojejunoplication. Regarding the pos toperative quality of life we supposed that there is an advantage for this reconstruction method compared to simple esophagojejunostomy. The following study investigated whether the pouch reconstruction by jeju noplication can develop a reservoir function and therefore a better cl inical course compared to jejunostomy. Without evidence of a local rec urrence after total gastrectomy 18 patients with and 18 without pouch reconstruction were evaluated by alimentary scintigraphy for at least 6 months after operation. Only patients were included with a tumor sta ge not exceeding T2 (UICC). The results of the transit times with a so lid radioactively labelled test meal were correlated with the complain ts and nutritional status of the patients, evaluated with a standardiz ed questionary for creating an individual score note. The transit in a jejunal pouch follows a linear decreasing function and is significant ly slower compared to the exponential passage of the jejunostomy. Both patterns remain still significantly accelerated compared to the physi ological ranges of gastric emptying. Patients with a pouch judge their postoperative individual state better than patients with simple jejun ostomy indicated with an on average symptom related score note better than 3. As long as the tumor stage is associated with a benefical prog nosis and the tumor localisation allows the reconstruction by an esoph agojejunoplication the formation of a pouch after total gastrectomy is recommended because of an improved transit pattern and clinical cours e.