Beese G, Fuchs K H, Thiede A
Chirurgische Klinik und Poliklinik, Universität Würzburg.
Zentralbl Chir. 1994;119(12):904-10.
Clinical relevant follow up parameters were used to examine the influence of an additional pouch for reconstruction after gastrectomy in Roux-en-Y technique and jejunal interposition in rats.
3 months old rats were gastrectomized and reconstructed as follows: Roux-en-Y (RY n = 50), jejunal interposition (JI n = 55) and each of these combined with a jejunal J-pouch (RYP n = 33; JIP n = 26). Up to 9 months postoperatively body weight, hemoglobin, iron, total protein and amylase as well as the pouch volume and esophageal mucosa were followed up.
All gastrectomized animals show deficiencies compared to non operated controls (n = 6). The severity depends on the type of reconstruction. The RY group overall has the lowest values; hemoglobin (9 month) 4.2 g/dl, body weight (6 mon) 77% total protein (9 mon) 47 g/l. JI causes less defect: Hb (9 mon) 8.3 g/dl, BW (6 mon) 109%, TP (9 mon) 61 g/l. Animals with additional pouch have better values than those with the similar type of reconstruction but without pouch; RYP: Hb (9 mon) 12.7 g/dl, BW (6 mon) 95%, TP (9 mon) 55 g/l; JIP: Hb (9 mon) 15.1 g/dl, BW (6 mon) 107%, TP (9 mon) 64 g/l. Hemoglobin and total protein do not significantly differ between the combination of interposition and pouch and the control group (p > or = 0.05). The volume of the pouch increases 1:3 during 6 months. Animals with pouch do not show severe reflux esophagitis as do those without pouch.
With global follow-up parameters the postgastrectomy deficiency can be evaluated in this experimental model. Interposition combined with the pouch is superior to the other methods as demonstrated by less deficiencies. Furthermore the pouch serves as a functional food reservoir and as reflux barrier.
