Proximal gastrectomy and jejunal pouch interposition: Evaluation of postoperative symptoms and gastrointestinal hormone secretion

Reflux esophagitis, dumping syndrome and malnutrition are included in the p ostgastrectomy complications. To prevent or minimize such sequelae, proxima l gastrectomy with an interposed jejunal pouch has been advocated as an org an-preserving surgical strategy to improve quality of life for the patients . Proximal gastrectomy was performed in 44 patients with tumors in the uppe r third of the stomach; 21 had reconstruction using jejunal pouch interposi tion between the esophagus and the remnant stomach (JP group), while 23 had reconstruction by esophagogastrostomy (EG group). Reconstruction method wa s selected by each patient on the basis of the informed consent. Thirty-fiv e patients had early gastric cancer. Postoperative courses of patients were reviewed in terms of symptoms, weight maintenance, nutritional status, blo od chemistry values, endoscopic findings, and radiographic appearances afte r a barium meal. Concentrations of gastrointestinal hormones were measured in response to a test meal. The JP procedure permitted increased dietary vo lume. The JP group showed fewer severe postoperative symptoms than the EG g roup. After operation, all patients examined in both groups showed hypergas trinemia and all patients examined in the JP group showed hypersecretinemia . In proximal gastrectomy, the JP procedure improved patient's postoperativ e quality of life.