Jejunal pouch interposition after total gastrectomy

: The results and procedures of interposed jejunal pouch after total gastrectomy for gastric cancer are reported. Basic requirements of reconstruction after total gastrectomy are 1) formation of a food reservoir, 2) maintenance of duodenal continuity, 3) avoidance of reflux esophagitis, 4) gradual emptying of reservoir into the small intestine. Since 1950's, several procedures of gastric substitutes have been reported. But they were not widely performed. Because scientific evaluation of the value of gastric substitutes was difficult and the operative procedures were time consuming and complicated. With an increasing ratio of early gastric cancer in 1990's, the importance of post-operative QOL, such as food intake and body weight maintenance, in patients after total gastrectomy has been recognized. Our procedure is a double lumen jejunal pouch distal to a interposed jejunum. The length of interposed jejunum is 20 cm and that of pouch is 10 cm. Using surgical staplers, this procedure is safe and simple. Jejunal pouch interposition leads to a satisfactory symptomatic and nutritional result in gastrectomized patients.