• Journal of Gastric Cancer
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• v.1 no.1
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• pp.38-43
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• 2001

Purpose: Roux stasis syndrome is the main complication of a Roux-en-Y gastrojejunostomy. The aim of this study was to compare the occurrence rate of Roux stasis syndrome with the passing of time in a conventional Roux-en-Y gastrojejunostomy and in an uncut Roux-en-Y gastrojejunostomy. Materials and Methods: 50 patients (31 men and 19 women) had a conventional Roux-en-Y reconstruction and 53 patients (35 men and 18 women) had an uncut Roux-en-Y reconstruction. The Roux stasis syndrome was defined by clinical criteria only. The criteria included one of the four following conditions at the time of follow-up: chronic upper abdominal pain, postprandial fullness, persistent nausea, and intermittent vomiting that are worsened by eating. Follow-up after surgery was done in all patients at $7\∼12,\;13\~18,\;19\~24,\;25\~30$, and $31\∼36$ months. Results: According to the criteria, the Roux stasis syndrome occurred in 40.0$\%$ of the patients at 7$\∼$12 months, 33.3$\%$ at $13\∼19$ months, $35.3\%$ at $19\∼24$ months, $32.0\%$ at $25\~30$ months, and $33.3\%$ at $31\∼36$ months after a conventional Roux-en-Y operation. The syndrome occurred in $22.6\%$ of the patients at $7\∼12$ months, $15.2\%$ at $13\∼18$ months, $17.1\%$ at $19\∼24$ months, $19.2\%$ at $25\∼30$ months, and $20\%$ at $31\∼36$ months after an uncut Roux-en-Y reconstruction. Conclusion: In terms of occurrence pattern, only a little variance existed one year after both procedures. Comparing the Roux stasis syndrome in both procedures, the uncut Roux operation had better results than the conventional Roux operation.

• Journal of Gastric Cancer
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• v.9 no.4
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• pp.215-222
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• 2009

Purpose: Billroth II gastroenterostomy is a typical reconstruction method after distal gastrectomy for gastric carcinoma, but it has problems, especially frequent reflux esophagitis. Various methods have been tried to address this problem. Among them are Braun enteroenterostomy and Roux-en-Y gastroenterostomy, which are performed separately according to the size of the gastric remnant. The aim of our study was to determine whether these applications are compatible. Materials and Methods: Between September 2003 and April 2007, we performed Roux-en-Y gastroenterostomy operations (14 patients) when the size of the gastric remnant was <10%, Braun enteroenterostomy (17 patients) when the size was between 10 and 20%, and Billroth II gastroenterostomy (14 patients) when the size was between 20 and 40% after subtotal gastrectomy for gastric cancer by a single surgeon at our hospital. We analyzed the results of each treatment. We evaluated the symptoms and endoscopic findings using questionnaires and hospital records. To evaluate nutritional states, we reviewed albumin and hemoglobin levels and body weight changes. Results: All operations were performed safely mortality was 0% and postoperative complications were 8.9%. On endoscopy, reflux gastritis was observed to occur in 7.63%, 18.65% and 40.0%, respectively, of patients who had undergone Roux-en-Y, Braun and Billroth II operations (P=0.13). Reflux esophagitis was observed in 1 patient in the Roux-en-Y group and 1 patient in the Braun group. Endoscopic gastrostasis was observed in 2 patients in the Roux-en-Y group, one of which was thought to cause reflux esophagitis. Patients in the Roux-en-Y group and Braun groups ingested a lower volume of food than did those in the Billroth II group (respectively, 7.1%, 0.0% and 28.7%) and complained less of postprandial discomforts (respectively, 14.3%, 23.5% and 57.1%) and reflux symptoms (respectively 0.0%, 11.8% and 42.9%). Conclusion: The application of Braun enteroenterostomy and Roux-en-Y gastroenterostomy to the small gastric remnant may be effective for reducing reflux symptoms and abdominal discomfort after distal gastric resection. We recommend Roux-en-Y gastroenterostomy when the size of the gastric remnant is <10%, and Braun anastomosis in the others. It will need to be determined which reconstructive procedure is better for many different conditions.

• Journal of Gastric Cancer
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• v.7 no.2
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• pp.88-96
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• 2007

Purpose: The only curative treatment for gastric carcinoma is surgery and it is still under debate which reconstruction method is better after performing gastrectomy for gastric carcinoma. The typical reconstruction methods after distal gastrectomy are Billroth I, Billroth II and Roux-en Y reconstruction. Yet it is difficult to compare these methods and not so much is known about which reconstruction is better in terms of the physiologic and nutritional function. With this background, we compared two reconstruction methods after distal gastrectomy (Billroth I versus Roux-en Y reconstruction) in terms of the long term physiologic function and nutritional status to create a reference for selecting reconstruction methods after distal gastrectomy. Materials and Methods: Between 1999 and 2002, 663 patients who underwent distal gastrectomy for early gastric carcinoma filled out questionnaires every six months after operation, and these questionnaires evaluated the physiologic function. To evaluate their nutritional status, blood tests were performed every six months to check their albumin, protein and hemoglobin levels, and we checked the body weight every 6 months as well. Results: The total score of the 15 questions on the questionnaire concerned with the physiologic function showed no difference between the two groups at every evaluation time, and both groups showed very low total scores, indicating tolerable physiologic function after operation. When comparing each question between two the groups, only symptoms of regurgitation and food passage showed a difference between the two groups, showing that the Roux-en Y group had better function in terms of these two symptoms. The Billroth I group showed a better nutrition status, indicating that the level of albumin, protein and hemoglobin were higher in the Billroth I group, with statistical significance. Body weight loss was severe in the Roux-en Y group. Conclusion: The physiologic function is slightly better in the Roux-en Y group in terms of some symptoms such as regurgitation and food passage. However, the nutritional status is better in the Billroth I group. In conclusion, because we cannot definitely ascertain which reconstruction is better when we consider both the physiologic and nutritional functions, it is reasonable that surgeon should choose reconstruction methods according to their experience and preference.

• Journal of Gastric Cancer
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• v.6 no.1
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• pp.52-56
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• 2006

A 69-year old man presented with severe epigastric pain for 1 day. He had early gastric cancer at the antrum and underwent a distal subtotal gastrectomy and Billorth II gastrojejunostomy one month later without any post-operative complications. Radiologic examination revealed a large amount of retroperitoneal free air formation. Because of unremitting pain and unstable vital sign, exploratory laparotomy was followed. During the operation, a perforated duodenal diverticulum at the posterior wall of the 2nd portion of the duodenum was identified. He underwent diverticulectomy and primary closure. He was discharged on the 18th post operative day and has been followed up without any evidence of comlpication for several months.

• Journal of Gastric Cancer
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• v.7 no.4
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• pp.219-227
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• 2007

Purpose: Many reconstruction procedures have been developed in order to resolve patient complaints after a total gastrectomy. However, until now, there has been no general agreement with regard to the ideal reconstruction to perform after a total gastrectomy. Moreover, there have been few reports of the long-term effects of different reconstruction procedures. In this study, we compared the long-term nutritional status and quality of life for patients that received either a Roux-en-Y esophagojejunostomy (R-Y), jejunal interposition (JI), jejunal pouch interposition (JPI), or double tract reconstruction (DT), to determine the optimum reconstruction procedure after a total gastrectomy. Materials and Methods: The study consisted of 41 patients younger than 80 years who had undergone a total gastrectomy with curative resection and who had no evidence of recurrence at our hospital between August 2000 and January 2004. The patients were classified into the following four groups, according to the type of reconstruction; simple Roux-en-Y (R-Y group, n=15), jejunal interposition (JI; group, n=8), j Jejunal pouch interposition (JPI group, n=8), double tract interposition (DT group, n=10). The nutritional status was assessed by measuring body weight, serum albumin level, serum hemoglobin level, and the level of serum total protein, and the PNI (Prognostic nutritional index). Quality of life was assessed by GSRS. In addition, endoscopy was performed to confirm the presence of reflux esophagitis. Results: The laboratory findings showed no significant differences between the four groups except for a lower total protein and album level in the DT group after 3 years postoperatively (P=0.006, P=0.033). The percentage of body weight at 1 year, and 3 years postoperatively in the JI group (P=0.013, P=0.011) were significantly less than other groups (P=0.011, P=0.000). The frequency of postoperative symptoms and reflux esophagitis and eating capacity showed no significant differences between the four groups. The GSRS score in the JIP group was significantly better than for the other groups at 1 year, and 3 years postoperatively (P=0.028, P=0.003). Conclusion: We believe that the jejunal pouch interposition is the most useful of the four procedures for improving postoperative quality of life.

• Journal of Gastric Cancer
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• v.4 no.4
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• pp.242-251
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• 2004

Purpose: Recently, because of the increasing numbers of early gastric cancer patients and improvements in their survivals, greater attention has been directed towards the quality of life and nutritional status of gastric cancer patients after surgery. However, conventional reconstructions, Billroth- I, -II (B-I and B-II) or Roux-en-Y, have proven to have certain limitations, such as a small reservoir, and a malabsorption for iron, fat, calcium, and carotene. To overcome these limitations, we used a jejunal pouch interposition(JPI) after a distal gastrectomy not only to substitute for the small reservoir but also to maintain a physiologic pathway for ingested foods. Materials and Methods: A total of 196 gastric cancer patients who underwent a distal gastrectomy between March 2001 and February 2004 were divided into 3 groups: JPI group (n=100), B-I group (n=29), and B-II group (n=67). We assessed the patient's nutritional status, gastric emptying time, and gastrofiberscopic findings. Results: The percents of body weight loss at 6 months, 1 year, and 2 years postoperatively in the JPI group ($5.14\%,\;3.01\%,\;2.37\%$) were significantly less than those of the conventional B-I ($8.41\%,\;6.69\%,\;5.90\%$) and B-II groups ($7.50\%,\;7.65\%,\;5.86\%$) (P=0.011, 0.000, 0.013). The laboratory findings showed no significant differences between the 3 groups, except for a higher total protein level in the JPI group after 6 months postoperatively. Especially, stage I and II cancers in the JPI group showed much higher total protein levels after 1 year postoperatively. The gastric emptying times in the $\^{99m}$Tc- semisolid scans at 6 months, 1 year, and 2 years postoperatively were 102.5, 83.1, and 58.1 minutes in the JPI group, 95.5, 92.0, and 58.5 minutes in the B-I group, and 53.9, 69.1, and 50.2 minutes in the B-II group, respectively. Also, the symptomatic gastric stasis detected with a gastrofiberscope during the early postoperative period (6 months) was gradually improved. Conclusion: From a nutritional aspect, a jejunal pouch interposition after a distal gastrectomy could be an alternative reconstruction method, especially in stage I and II gastric cancer patients, in spite of the longer operation time and the probable delayed gastric emptying.

• Journal of Gastric Cancer
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• v.8 no.2
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• pp.97-103
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• 2008

Purpose: Radical surgery is the standard therapy for patients with resectable cardia cancer. In the case of type II disease with esophageal invasion, a transhiatal extended radical total gastrectomy is needed or a gastroesophagectomy through an abdomino-thoracotomy, depending on the extent of the esophageal invasion. We analyzed the indications and outcome of left colon interposition as an esophageal substitution. Materials and Methods: Between 1 January 1994 and 31 December 2006, 10 patients underwent left colon interposition after gastroesophagectomy through an abdomino-thoracotomy or the tanshiatal approach for type II cardia cancer at the Department of surgery, Yonsei University College of Medicine. The outcomes of these patients were reviewed and compared, with those who underwent a Roux-en-Y, by gender and age matched analysis, retrospectively. Results: There were nine males and one female with a mean age of 52.5 (range, 16~72). The operation time was $449.00{\pm}87.39minutes$. The mean distance between the proximal resection margin and the cancer was $6.56{\pm}3.65cm$; the maximum size of the tumor was $9.90{\pm}3.97cm$. These measures differed significantly from patients who underwent Roux-en-Y. The patients had a double primary cancer in the cardia and esophagus. There were no events of colon necrosis. However, a pneumothorax occurred in one patient (10%) and a proximal anastomotic stricture occurred in one patient. There were no reports of heartburn, regurgitation, thoracic or epigastric fullness, and one patient even gained weight, 16 kg. Conclusion: Colon interposition after esophagogastrectomy was safe and effective and should be considered as an additional surgical option for locally advanced type II cardia cancer patients with esophageal invasion.