Nutritional state, growth rate, and morphology after total gastrectomy with restoration of duodenal passage or Roux-en-Y oesophagojejunostomy with or without a pouch: an experimental study in pigs.

OBJECTIVE

To compare the effect of restoration of duodenal continuity by a Roux-en-Y oesophagojejunostomy with or without a pouch on nutritional state, growth, and morphology after total gastrectomy in pigs.

DESIGN

Experimental study.

SETTING

Teaching hospital, Sweden.

MATERIAL

60 Swedish domestic pigs.

INTERVENTIONS

54 pigs underwent total gastrectomy and 6 had sham operations. 20 pigs had reconstruction by a Roux-en-Y oesophagojejunostomy, 21 had a jejunal loop interposed between the oesophagus and the duodenum, as 13 had a oesophagojejunostomy with jejunal pouch on a Roux-en-Y loop.

MAIN OUTCOME MEASURES

Weight, laboratory indicators of nutritional state, and histological appearance of the gut.

RESULTS

Growth was significantly retarded in those pigs that had had gastrectomies (p < 0.001) but there were no differences among the experimental groups. Haemoglobin, albumin, and calcium concentrations were significantly lower in the experimental groups than in the control group (p=0.006, 0.02, and 0.002, respectively). Histological examination showed subtotal villous atrophy in the experimental groups, most obvious in the pouch group. Colonic mucosal height was reduced in the experimental groups.

CONCLUSION

This study failed to show any advantage in growth rate when restoration of duodenal continuity or a small bowel pouch were compared with a conventional Roux-en-Y oesophagojejunostomy after total gastrectomy. However, restored duodenal passage seemed to benefit calcium homeostasis.