[Reconstructive method of the alimentary tract after total gastrectomy].

In this report, four different procedures were adopted to reconstruct the alimentary tract after total gastrectomy performed for gastric carcinoma in 92 cases. They were end to side (or end to end) esophagojejunostomy (48 cases), rho-shaped esophagojejunostomy (28 cases), and end to end esophagoduodenostomy (16 cases). The incidence of anastomotic leakage was 4.3%, the operative mortality 2.2%. No anastomotic leakage occurred in the rho-shaped esophagojejunostomy group which is considered to be safe and effective. Though end to end esophagoduodenostomy has the advantage of being simple and time sparing, it can not be applied to all patients for the tension at the site of anastomosis. It might be indicated when the tumor is located in the greater or lesser curvature with the cardiac or pyloric end not involved, or when the distance between the lower end of the esophagus and the upper border of duodenum cone is not larger than the width of 1.5 vertebral body.