Intestinal pouches: gastric reconstruction

Reconstruction of the intestinal passage after a total gastrectomy is usual ly based on a direct esophagojejunostomy with end-to-side implantation of t he afferent loop. The second principle of reconstruction is based on preser vation of the duodenal passage. Longterm problems such as weight loss and m alnutrition are further considerations that lead to the concept that gastri c reconstruction should have the form of a reservoir. In addition to the co nstruction of the reservoir itself, the clinical concern of avoiding gastro esophageal reflux is a further requirement for the choice of reconstruction type. Diversion of the duodenal content via a Roux-en-Y end-to-side anasto mosis is considered to be the standard procedure. Interposition of a suffic iently long duodenal loop with maintenance of the duodenal passage also has the effect of preventing duodenal reflux. A theoretical advantage of this procedure is the linking of the motility of the duodenum with that of the i nterposed segment. with improved synchronization of the aboral nutrient pas sage. When one considers complicated reconstructive procedures, the present literature suggests construction of a pouch is definitely functionally sup erior to the simple esophagojejunostomy. Whether the duodenal passage shoul d be maintained or whether a Roux-Y technique should be used is a question that is still open for discussion.