Michiya Kobayashi, M.D., Ph.D.
Professor
Department of Human Health and Medical Science,
Kochi Medical School,
Nankoku, Japan
Ken Okamoto, M.D.
Department of Surgery,
Kochi Medical School,
Nankoku, Japan
Takehiro Okabyashi, M.D., Ph.D.
Department of Surgery,
Kochi Medical School,
Nankoku, Japan
Toyokazu Akimori, M.D.
Department of Surgery,
Kochi Medical School,
Nankoku, Japan
Tsutomu Namikawa, M.D., Ph.D.
Assistant Professor
Department of Surgery, Kochi Medical School,
Nankoku, Japan
Junichi Sakamoto, M.D., Ph.D.
Professor
Young Leaders Program,
Nagoya University Graduate School of Medicine,
Nagoya, Japan
Kazuhiro Hanazaki, M.D., Ph.D.
Professor
Department of Surgery,
Kochi Medical School,
Nankoku, Japan
The most prominent and severe complication after a total gastrectomy is severe reflux esophagitis. We have developed a procedure involving jejunal pouch-esophagostomy to avoid such postoperative reflux. The novel procedure reported here initially involves folding a jejunal segment of approximately 35 cm in length. A side-to-side jejuno-jejunostomy at the anti-mesenteric side was then affected using a 100-mm linear stapler. This resulted in a jejunal pouch, 10 cm in length, and a 7-cm apical section of unstapled jejunal loop. Finally, an esophago-jejuno end-to-side anastomosis (pouch-esophagostomy) was formed at the right anterior wall of the apical bridge using a circular stapler. We have therefore introduced a "partial posterior fundoplication"-like wrapping technique to the standard gastrectomy using the apical bridge of the jejunal pouch. Only a little postoperative reflux was revealed by barium meal testing - even in the Trendelenburg's position - in patients treated with the described anti-reflux anastomosis procedure. Jejunal pouch reconstruction with partial posterior wrapping is a useful procedural addition for minimizing reflux esophagitis following a total gastrectomy.
