Reconstruction modes following gastrectomy. Results of experimental and clinical controlled trials

In animal experiments four reconstruction methods following gastrectomy were compared: Roux-en Y reconstruction with (n = 33) and without pouch (n = 50) and isoperistaltic jejunum interposition with (n = 26) and without pouch (n = 55). The results were mostly influenced by the extent of esophagitis, documenting the reflux reduction by a pouch. Weight gain was slightly higher following jejunum interposition. Roux-en Y pouch reconstruction with jejunum interposition with pouch was compared in a randomized controlled trial. The additional operative effort of jejunum interposition did not achieve benefits in outcome. Therefore, Roux-en Y reconstruction should be advocated as standard reconstruction. The second randomized controlled trial compared Roux-en Y reconstruction with and without pouch. After more than three years, there was an advantage in life quality for patients with pouch indicating that patients with a favorable prognosis following gastrectomy should be reconstructed with a pouch.