Reconstruction after total gastrectomy by the interposition of a double jejunal pouch using a double stapling technique

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Abstract
Background: After total gastrectomy, sustaining good nutrition is extremely important for maintaining quality of life. A technique of neogastric pouch formation based on current physiological reconstructive principles is presented. Methods: The use of a modified interpositioned double jejunal pouch following total gastrectomy in 18 patients with cancer was reviewed. This technique results in a complete pouch and uses a double stapling technique with site-specific anastomosis between the oesophagus and pouch, in which a Hisoid angle is created. Results: There were no anastomotic leaks and pouch blood flow was within normal expected limits. Mean oesophageal pH above 7·0 for one 24-h period was 7·7 per cent. Emptying half-time was 67·8 min. After 2 years mean body-weight was 98·3 per cent of expected, mean food volume was 94·0 per cent of expected and mean meal frequency was 3·0 per day. Conclusion: This form of gastric reconstruction is an acceptable procedure which improves the quality of life in patients undergoing total gastrectomy.