J.Jpn. Surg. Soc.. 99(9): 569-574, 1998

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Feature topic

A NEW RECONSTRUCTION PROCEDURE AS ANTIREFLUX SURGERY AFTER PROXIMAL GASTRECTOMY INTERPOSITION OF THE JEJUNAL POUCH WITH VALVULOPLASTY

In order to reduce the incidence of reflux esophagitis following proximal gastrectomy, we have developed a new reconstruction procedure with an interposed jejunal pouch wlth antireflux valvuloplasty between the esophagus and the gastric remnant. After a standard proximal gastrectomy and lymph node dissection, the jejunum is divided at a point 25cm from the Treitz ligament. The distal jejunum is pulled up through the transverse mesocolon with a mesenterium and anastomosed to the esophagus with a PCEEA stapling device. The pulled through jejunum is doubled up at a point 30cm from the esophagojejunostomy, and the 5cm tip of the jejunum ls resected. A 5.5cm autosuture GIA is inserted into the jejunum frorn both cut ends of the jejunum for side-to-side anastomosis on the antimesenteric side to make a 5cm long jejunal pouch, and the jejunum is further divided 5cm distal from the jejunal pouch. As a result, the interposed lejunal segment is omponed of a single-lumen 15cm jejunum, a parallel lumen 5cm jejunum, and a double-lurnen jejunum. In the double-lumen jejunum, the jejunal pouch plays the role of a pressure absorber in the residual stomach, and the septum of the parallel lumen jejunum that of an anti-reflux valve. Peristalsis of the single Iumen 15cm jejunum prevents reflux to the esophagus. Postoperative examinations showed that this reconstruction method has satisfactory to excellent results.

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