RESTORATION of the physical continuity of the gastrointestinal tract after total gastrectomy has not been a problem.
Restoration of the physiological continuity to the degree that the patient has minimal adjustment has been a problem.
Interposing a segment of intestine between the esophagus and duodenum or jejunum after total removal of the stomach appears to retain this physiological continuity in a more adequate manner. Various segments have been used for this interposition operation—the jejunum (Longmire1), the transverse colon, and the right ileocolon. In the cases in which the right ileocolon has been used to replace the stomach, the physiological continuity appears to be retained in that the interposed segment accepts swallowed food at a reasonable rate without exhibiting irritability or resentment. In turn, this interposed segment presents this ingested food for acceptance by the duodenum at a rate, consistency, and concentration that require minimal adjustment on the part of
ARTHUR J. HUNNICUTT, LAURANCE W. KINSELL. ILEOCOLON REPLACEMENT OF STOMACH AFTER TOTAL GASTRECTOMYClinical Observations and Physiological Studies. AMA Arch Surg. 1954;68(4):511–518. doi:10.1001/archsurg.1954.01260050513014