Histologic Evaluation of the Gastrointestinal Tract and Pancreatic Changes After Laparoscopy-Assisted Distal Gastrectomy in Canine Model

Abstract

Article history: Received: 04 Jul 201 Revised: 29 Nov 2011 Accepted: 21 Dec 2011 Article type: Original Article Background: Total and partial gastrectomy is commonly used to treat gastric carcinoma or other benign or malignant conditions of the stomach. Laparoscopic-assisted distal gastrec- tomy is an alternative approach for treating mucosal gastric cancer. Many investigators have assessed the safety, efficacy, and feasibility of this procedure. Objectives: The aim of present study is to compare the outcomes obtained using Roux-en-Y and Jejunal Loop Interposition reconstructive techniques after laparoscopic-assisted distal gastrectomy and determine the gross pathologic and histological changes in the anasto- motic area and the macroscopic and microscopic pancreatic changes 1 and 3 months after the surgery. Materials and Methods: Twelve adult healthy male mixed-breed dogs were divided randomly into 2 groups of 6 animals each. In group A, left gastroepiploic vessel and its branches, gas- troepiploic ligament, and right gastroepiploic vessels were ligated and resected laparoscopi- cally. A loop of jejunum, 20 cm distal to the Treitz ligament, was resected and end-to-side anastomosis was performed between the distal jejunal end and remaining part of the stom- ach. The proximal jejunal end was end-to-side anastomosed to the rest of the jejunum. In group B, gastrectomy was performed in the same manner. A 20-cm jejunal loop, 20 cm from the Treitz ligament, was resected, and the remaining part of the stomach and jejunum was anastomosed. Jejunojejunostomy was performed between the two remaining jejunal parts. Results: Esophagoscopy showed no en bloc resection of the esophagus or alkaline gastritis. A 2-cm by 2-cm ulcerative mass was observed in the remaining part of the stomach close to gastrojejunal anastomotic site in one patient of group A. The animals were authanized one and three month after the surgery. Macroscopic evaluation revealed normal healing of the incisional scars without any inflammation, abscess, adhesion, or other acute or chronic in - flammatory reactions. Microscopic evaluation of the pancreatic sections revealed normal appearance of the gland structure, Langerhans islets, and ductal systems without any in- flammatory reaction. Decrease in the number of zymogen granules was noted in most of the cases. The junction between the esophagus and stomach was normal in all the cases, and no inflammatory, degenerative, proliferative, hypoplastic, necrotic, hemorrhagic, edemic, and ulcerative changes were noted. There were no pathologic abnormalities in any of the esophagogastric junction sections. In the gastrojejunal anastomotic sites, decreased stom- ach thickness at the anastomotic site and cystic dilatation of the jejunal crypts was noted. Conclusions: Upper gastrointestinal endoscopy was found to be a useful and feasible tech- nique to detect esophageal gastritis; anatomical structure, obstruction, or stenosis; and oth- er disorders of the upper gastrointestinal tract. In addition, the 2 reconstructive techniques used following gastrectomy yielded similar endoscopic and pathologic findings.