Long-term follow-up of patients with jejunal pouch reconstruction after total gastrectomy - A randomized prospective study

Background: Fifty-one patients were operated on during 1988-1992 and random ized after total gastrectomy to one of two reconstruction types. Twenty pat ients with jejunal pouch reconstruction and 14 patients with Roux-en-Y reco nstruction (67% of all) survived at least 3 years after total gastrectomy. We studied symptoms, eating capacity, and nutrition in these patients durin g the clinical follow-up; 21 patients were assessed by mail questionnaire 8 years after total gastrectomy. Methods: Postoperative symptoms, number of meals, and eating capacity were assessed by standard questionnaire during 3 years' follow-up. Weight loss and nutritional laboratory variables were me asured, and upper intestinal endoscopy with biopsy was performed during the follow-up. Eight years after the operation symptoms, ability to eat, and n umber of meals consumed were studied by means of a mail questionnaire. Resu lts: Three years postoperatively dumping (64% compared with 10%, P < 0.05) and early satiety (86% compared with 5%, P < 0.05) were commoner in the Rou x-en-Y group. In the pouch group eating capacity was better (96% of normal compared with 67%, P < 0.05), and the patients ate fewer meals per day (mea n, 2.7 versus 5.3, P < 0.05) at 3 years. Mean weight loss at 3 years was 9. 9 kg in the Roux-en-Y group compared with 1.5 kg in the pouch group (P < 0. 05). 25 (OH) vitamin D concentration tended to be higher in the pouch group (47.3 nmol/l compared with 33.9 nmol/l). In the Roux-en-Y group serum alka line phosphatase activity increased significantly during the 3 postoperativ e years (from mean 163 U/l to 248 U/l, P < 0.01) and tended to be higher (2 48 U/l compared with 216 U/l in the pouch group). None of the patients deve loped oesophagitis or pouchitis during the follow-up. One patient developed a bezoar in the pouch 5 years after grastrectomy. Conclusions: Pouch recon struction after total gastrectomy is associated with diminished postoperati ve symptoms, better eating capacity, and decreased weight loss compared wit h Roux-en-Y reconstruction. Jejunal pouch reconstruction is thus the recomm ended surgical method after total gastrectomy.