Emptying of the jejunal pouch and Roux-en-Y limb after total gastrectomy--a randomised, prospective study.

OBJECTIVE

To investigate the emptying of solids after total gastrectomy with pouch reconstruction.

DESIGN

Randomised, prospective study.

SETTING

University hospital, Finland.

SUBJECTS

49 patients with gastric carcinoma operated on for cure between 1988 and 1992.

INTERVENTIONS

After total gastrectomy 26 patients were randomised to have a pouch reconstruction and 23 a Roux-en-Y reconstruction. 15 months after the operation 24 patients with a pouch (pouch group) and 21 patients with a simple Roux-en-Y reconstruction (Roux-en-Y group) were alive and available to have an emptying test by the solid isotope method. Emptying of the pouch and Roux-en-Y limb was assessed by measuring the activity at 3 hours.

MAIN OUTCOME MEASURES

Postoperative symptoms, size of meal, and postoperative nutrition.

RESULTS

Emptying was significantly slower after pouch reconstruction than after Roux-en-Y (mean activity at 3 hours 82% and 44%, respectively, p < 0.01). Early satiety occurred in 10 (48%) of the patients after Roux-en-Y reconstruction and 6 (25%) in the pouch group. Dumping was more common in the Roux-en-Y group (n = 12, 57% compared with n = 6, 25%, p = 0.04). 19 (79%) of the patients in the pouch group were able to eat normal sized meals compared with 3 (14%) in the Roux-en-Y group (p < 0.0001). Weight gain and haemoglobin and albumin concentrations were similar in the two groups.

CONCLUSION

Jejunal pouch reconstruction after total gastrectomy delays passage of solid food in the upper intestine compared with Roux-en-Y reconstruction. It is associated with better eating capacity and fewer postoperative symptoms.