Evidence-based recommendations for the reconstruction after total gastrectomy

E. Strong (ed.). Gastric cancer. Principles and practice. Springer (2015)

Two important questions concerning the reconstruction after gastrectomy have been addressed by meta-analyses, combining each several RCTs. Concerning the construction of a pouch, the pooled data clearly shows a clinical benefit for patients receiving a pouch together with a RY reconstruction, at least for the first postoperative year. Reflux, as well as dumping syndrome, eating capability, and quality of life are significantly better with than without pouch, while morbidity and mortality rates are similar. Data on pouch reconstruction after jejunal interposition document no increased mortality when a pouch is included, but data on postgastrectomy syndromes and quality of life are not strong enough to draw decisive conclusions yet. Concerning the preservation of the duodenal passage, construction of a jejunal interposition with and without a pouch is not associated with a higher mortality or morbidity rate compared to RY, while operation time is significantly longer. Postgastrectomy syndromes in pouch reconstructed patients as well as quality of life did not show a benefit for jejunal interposition. Both procedures can thus be performed on par based on current knowledge.

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