CLINICAL EVALUATION OF A MODIFIED ρ-GRAHAM OPERATION FOR TOTAL GASTRECTOMY

In 99 cases (62 in males, 37 in females) undergoing total gastrectomy during the 10.5 years since September 1975, the Roux-en Y, ρ-type reconstruction was performed. Clinical evaluation of postoperative esophageal reflux was undertaken, based on clinical symptoms, contrast X-ray examination, endoscopy and manometric investigation to the types of gastro-jejunostomy: Graham type anastomosis (GA) in 36 cases, manual anastomosis (MA) in 38 cases and EEA-autosuture anastomosis (EEA) in 25 cases. The following results were obtained. Clinical symptoms suggestive of reflux esophagitis appeared in 44.8% of the MA group and in 8% of the EEA group, but not in the GA group. Esophageal reflux on X-ray examination occured in 28.9% of the MA group, but in only 2 cases of the EEA group and in only one case of the GA group. Endoscopic examination showed definite reflux esophagitis in 4 cases of the MA group, but there was no endoscopic abnormality in groups EEA and GA. The tone value measured by an open-tip method in the high pressure zone (HPZ) was lowest in the MA group. The tone value was significantly higher in the GA group than in the other 2 groups and was almost the same as that of the normal control. Values of length at the HPZ showed findings similar to the tone values. The jejuno-esophageal pressure gradient in the GA group was significantly lower than in the other 2 groups. Those values were significantly in patients with clinical complaints than in those without complaints. A common cavity phenomenon was noted in 4 cases of the MA group by test reflux examination of the jejuno-esophageal portion using a 3-lumen catheter. According to these results, it appears that Graham anastomosis following total gastrectomy was the best reconstruction method from the point of view of postoperative reflux esophagitis, esophageal manometric observation was very useful for the clinical evaluation.