Lower oesophageal sphincter‐preserving Roux‐en‐Y esophagojejunostomy with a jejunal J‐pouch reconstruction‐added His angle formation after total gastrectomy in patients with gastric cancer

Abstract

AimThe aim of the present study was to prevent post‐gastrectomy disorders (PGD), such as alkaline reflux esophagitis (ARE), early dumping syndrome (EDS) and microgastria, in patients after total gastrectomy for advanced gastric cancer. We performed lower oesophageal sphincter (LES)‐preserving Roux‐en Y with jejunal J‐pouch reconstruction and His angle formation (LRYJPH). We introduce the application criteria, technical points and results of the LRYJPH procedure.Patients and MethodsTwenty‐eight patients who underwent LRYJPH in our hospital from October 2014 to August 2015 were studied. The application criteria were gastric cancer patients (stages II, IIIA and IIIB) who could undergo radical surgery and tumour mainly localized at the middle third of the stomach, with its anal side 5.5 cm or further from the esophagogastric mucosa junction. To preserve the LES, the abdominal oesophagus was resected at the level of the His angle. To make a jejeunal J pouch, a plicated jejunal loop of 15 cm in length was made. After end‐to‐side esophagojejunostomy of the jejunal J pouch, a His angle was created on the left‐side abdominal oesophagus.ResultsThe patient’s appetite was unchanged compared with before the operation. Symptomatic and endoscopic ARE, food stasis in the jejunal J pouch and microgastria were all absent. EDS was 8.3 per cent. The level of satisfaction after the operation was 100 per cent.ConclusionLRYJPH is appropriate to prevent PGD. This procedure is safe and facilities satisfactory results.