[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
July 1987

Pouch and Roux-en-Y Reconstruction After Gastrectomy

Author Affiliations

From the Department of General Surgery, Christian-Albrechts-University, Kiel, Federal Republic of Germany (Drs Thiede and Hamelman); and the Department of Surgery, Creighton University, Omaha (Dr Fuchs).

Arch Surg. 1987;122(7):837-842. doi:10.1001/archsurg.1987.01400190103024

• We evaluated a reconstruction procedure of the upper gastrointestinal tract after total gastrectomy with the exclusive use of the EEA, GIA, and TA surgical stapling devices (United States Surgical Corp, Norwalk, Conn). Twenty patients with gastric carcinoma entered the study. A total gastrectomy and lymphadenectomy was performed in each patient and the upper gastrointestinal tract was reconstructed by the Roux-en-Y technique with the creation of a Hunt-Lawrence-Rodino pouch. For all operational steps, surgical staplers were used exclusively, as follows: (1) duodenal closure, GIA or TA; (2) Roux-en-Y anastomosis, EEA 25; (3) pouch construction, GIA (three to four times); (4)esophagojejunostomy, EEA 25; and (5) pouch closure, TA 55 or 90. There was a one-hour difference in operating time between patients operated on exclusively by the staple technique and TNM—matched patients operated on manually. Four patients suffered from general complications. Two patients had clinically relevant suture deficiencies. We concluded that current reconstruction methods after gastrectomy that fulfill the reservoir function (pouch) and reflux prevention (Roux-en-Y reconstruction) can be achieved by the combination and systematic use of straight and circular staplers. The advantages are intraoperative time saving and a relaxation of limitations imposed on an abdominal intervention by age and localization of the tumor.

(Arch Surg 1987;122:837-842)

Troidl H, Kusche J:  Lebensqualität nach Gastrektomie: Ergebnisse einer randomisierten Studie zum Vergleich Oesophago-Jejunostomie nach Schlatter mit dem Hunt-Lawrence-Rodino-Pouch , in Rohde H, Troidl H (eds): Das Magenkarzinom . Stuttgart, W Germany, Georg Thieme Verlag, 1984, pp 84-91.
Hunt CJ:  Construction of food pouch from segment of jejunum as a substitute for stomach in total gastrectomy . Arch Surg 1952;64:601-608.Article
Lawrence W Jr:  Reservoir construction after total gastrectomy. Ann Surg 1962;155:191-198.Article
Ravitch MM, Steichen FM:  Surgical stapling techniques . Surg Clin North Am 1984;64:543-554.
Chassin JL, Rifkind KM, Sussman B, et al:  The stapled gastrointestinal tract anastomosis: Incidence of postoperative complications compared with sutured anastomosis . Ann Surg 1978;188:689-696.Article
Reiling BR, Reiling WA, Bernie WA, et al:  Prospective controlled study of gastrointestinal stapled anastomoses . Am J Surg 1980;139:147-152.Article
Beart RW, Kelly KA:  Randomized prospective study of the EEA stapler for colorectal anastomoses . Am J Surg 1981;141:143-147.Article
Thiede A, Schubert G, Poser HL, et al:  Zur Technik der Rectumanastomosen bei Rectumresectionen: Eine kontrollierte Studie: Instrumentelle Naht versus Handnaht . Chirurg 1984;55:326-335.
Visick AH:  Measured radical gastrectomy . Lancet 1948;1:505-555.Article
Spitzer WO, Shenker SC:  Messen der Lebensqualität bei Karzinompatienten: Zur Entwicklung eines exakten Lebensqualitätsindex , in Rohde H, Troidl H (eds): Das Magenkarzinom , Stuttgart, W Germany, Georg Thieme Verlag, 1984, pp 62-73.
Junginger TH, Walgenback S, Pichlmaier H:  Die zirkuläre Klammeranastomose (EEA) nach Gastrektomie . Chirurg 1983;54:161-165.
Hopkins RA, Alexander JC, Postlethwait RW:  Stapled esophagogastric anastomosis . Am J Surg 1984;147:283-287.Article
Wheeless CR, Smith JJ:  A comparison of the flow of iodine 125 through three different intestinal anastomoses: Standard, Gambee and stapler . Obstet Gynecol 1983;62:513-518.
Barone RM:  Reconstruction after total gastrectomy: Construction of a Hunt-Lawrence Pouch using Auto Suture Stapler . Am J Surg 1979;137: 578-584.Article
Bradley EL, Isaacs J, Hersh T, et al:  Nutritional consequences of total gastrectomy . Ann Surg 1974;182:415-429.Article