Jejunal pouch to avoid stricture after esophagojejunostomy with circular stapler

Background: Anastomotic stricture is one of the most common problems in eso phagojejunostomy using the end-to-end anastomosing (EEA) instrument (Auto S uture Co, Norwalk, CT) after total gastrectomy. To alleviate the stricture, several methods, such as incision to the scar, balloon dilatation, and ste roid injection are available. To avoid stricture, the jejunal pouch may all ow use of a larger EEA than Roux-en-Y (ReY) reconstruction does. Study Design: A total of 45 patients underwent curative total gastrectomy a nd esophagojejunostomy with jejunal pouch construction (27 patients) or ReY (18 patients), using the EEA. The effects of jejunal pouch construction wi th a large EEA. on avoidance of stricture and benefit to nutritional status were investigated by comparing it with the ReY in terms of postoperative m orbidity, postprandial symptoms, and nutritional parameters (serum protein, serum albumin, body weight). Results: EEA28 or larger could be used in 25 patients in the pouch group an d 8 patients in the ReY group (p < 0.05). Stricture developed in one patien t in the pouch group and in four patients in the ReY group (p < 0.05); Post prandial symptoms were experienced less frequently (p < 0.05) in the pouch group than in the ReY group. When stricture and symptoms were analyzed acco rding to the size of EEA, they occurred more frequently (p < 0.05) in the p atients with EEA25 than those with EEA28 or EEA31. No significant differenc es were evident in nutritional parameters. Conclusions: The choice of jejunal pouch technique allowed the use of a lar ger EEA than that of ReY reconstruction, resulting in avoidance of anastomo tic stricture and postprandial symptoms, though little benefit in nutrition al status was evident to the patients after total gastrectomy. (J Am Coll S urg 1999;189:466-469. (C) 1999 by the American College of Surgeons).