TECHNICAL DEVICES IN JEJUNAL POUCH RECONSTRUCTION FOLLOWING TOTAL GASTRECTOMY, INCLUDING POSTOPERATIVE RESULTS

Background/Aims: Either straight Roux-en-Y anastomosis or jejunal inte rposition used to be adopted following total gastrectomy. However, dis satisfaction with regard to postoperative quality of life has prompted the development of new techniques. The purpose of this study is to de scribe and assess the authors' technical devices in jejunal pouch (J-p ouch) reconstruction following total gastrectomy and the results of th ese operations. Patients and Methods: A prospective study of 17 patien ts with malignant gastric disease (nine with J-pouch interposition, ei ght with J-pouch Roux-en-Y reconstruction) was performed. To facilitat e the side-to-side anastomosis of the jejunal loop, the authors used a n autosuture instrument. The anastomosis was then checked for hemostas is using a vaginoscope. Results: An Endo GIA with a 60-mm long white c artridge (closed height of staples, 1.0 mm) is the instrument of choic e to create the J-pouch. This autosuture instrument fires triple stagg ered staple lines, which minimizes bleeding from the anastomosed site and reduces operative time. No anastomotic leaks were associated with the autosuture instrument. The vaginoscope facilitates a direct observ ation of the staple lines internally and if necessary, enables secure hemostasis with sutures. Bowel motility was satisfactory for both surg ical procedures, as measured by the percentage of radiopaque markers w hich were expelled from the pouch. There were no serious complications , and all patients have currently survived, a maximum of 5 years and 6 months after surgery, except for one patient who died from recurrent disease. Conclusion: The authors' procedures for J-pouch reconstructio n are advantageous due to a favorable post-operative quality of life, with low complication rates.