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August 1962

Jejunal Loop Interposition: A Word of Caution

Author Affiliations

Associate Professor of Surgery, Department of Surgery, University of Washington.; From the Department of Surgery, University of Washington School of Medicine.

Arch Surg. 1962;85(2):223. doi:10.1001/archsurg.1962.01310020053011

In a recent communication, Walters and Tama1 reported the use of an interposed jejunal segment between the gastric remnant and duodenum in a patient with severe postgastrectomy dumping syndrome. The patient was alleviated of his incapacitating symptoms almost immediately. This further corroborates the excellent results reported by Henley2,3 and Hedenstedt4,5 of jejunal interposition for relief of this serious postgastrectomy complication.

Walters and Tama1 mention the risk of anastomotic ulcer following this operative technique. Greater emphasis must be made of this point. The procedure is an ulcerogenic preparation unless a certain precaution is taken. Acid-peptic juice from the gastric remnant pours over the unprotected jejunal mucosa at the proximal anastomosis. At this point, the jejunal mucosa is spatially removed from the protective duodenal chyme. Anastomotic ulcer is very prone to develop. Henley6 reported a 17% and Hedenstedt7 a 9% stomal ulceration rate in their early

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