Long-term beneficial effects of a gastric reservoir on weight control after total gastrectomy: a study of potential mechanisms

Background Weightless after total gastrectomy is a regular occurrence. Reconstruction with a gastric substitute has been suggested to facilitate recovery but few randomized studies are available. Methods In a randomized study comparing subtotal, total and total gastrectomy with an S-shaped pouch, 36 patients who had total gastrectomy with or without a pouch survived for more than 3 (mean 5.2) years. Body composition (four-chamber model, dual-energy X-ray absorptiometry, anthropometric data) was evaluated before operation, after 12 months and at long-term follow-up. Food intake was registered as a 4-day food record at 12 months and at long-term follow-up. Results At long-term follow-up those allocated to the gastric substitute arm had lesser degrees of weight loss consisting mainly of the depletion of body fat stores, whereas lean body mass showed no significant decrease when adjusted for the process of ageing. There was no significant difference in food intake. Conclusion Reconstruction with an S-shaped gastric substitute facilitates long-term recovery after total gastrectomy and should be considered when the prognosis is favourable.