JEJUNUMPOUCH NACH TOTALER GASTREKTOMIE - KLINISCHE UND SZINTIGRAPHISCHE UNTERSUCHUNGEN ZU FUNKTION UND BEFINDLICHKEIT

The formation of a pouch is a surgical procedure to restore the lost of reservoir function after resection of the stomach. After total gastrectomy the intestinal passage can be reconstructed by a jejunal pouch performing a Siewert/Peiper esophagojejunoplication. Regarding the postoperative quality of life we supposed that there is an advantage for this reconstruction method compared to simple esophagojejunostomy. The following study investigated whether the pouch reconstruction by jejunoplication can develop a reservoir function and therefore a better clinical course compared to jejunostomy. Without evidence of a local recurrence after total gastrectomy 18 patients with and 18 without pouch reconstruction were evaluated by alimentary scintigraphy for at least 6 months after operation. Only patients were included with a tumor stage not exceeding T2 (UICC). The results of the transit times with a solid radioactively labelled test meal were correlated with the complaints and nutritional status of the patients, evaluated with a standardized questionary for creating an individual score note. The transit in a jejunal pouch follows a linear decreasing function and is significantly slower compared to the exponential passage of the jejunostomy. Both patterns remain still significantly accelerated compared to the physiological ranges of gastric emptying. Patients with a pouch judge their postoperative individual state better than patients with simple jejunostomy indicated with an on average symptom related score note better than 3. As long as the tumor stage is associated with a benefical prognosis and the tumor localisation allows the reconstruction by an esophagojejunoplication the formation of a pouch after total gastrectomy is recommended because of an improved transit pattern and clinical course.