Restoration of the alimentary tract after total gastrectomy using autosuture staplers

Abstract

The first successful total gastrectomy was performed by Schlatter [I] in 1897. Schlatter restored digestive tract, continuity with an end-to-side esophagojejunostomy. For the next fifty years many ineffective surgical procedures were tried to correct the incapacitating esophagitis and malnutrition accompanying end-to-side esophagojejunostomy. In 1947 Orr [2] solved the problem of reflux esophagitis by dividing the jejunum below the ligament of Treitz and anastomosing the esophagus to the distal jejunum. The afferent jejunal limb was joined to the efferent jejunal limb below the anastomosis. In 1952 Hunt [3] introduced the creation of a jejunal pouch as a reservoir to improve absorption and correct the disabling problems of dumping and weight loss. The publication in 1962 of Lawrence’s most demonstrative case [4] clanged the bell that awakened the surT gical world to the importance of the Hunt pouch with the Orr Roux-en-Y alkaline diversion. In 1968 Scott, Gobbel, and Law, [5,6] further confirmed the value of the procedure with their experience. Paulino [7] noted that his patients with a Hunt-Lawrence pouch frequently had disagreeable symptoms of regurgitation. He evaluated these patients and discovered that they did not have esophagitis, but they did have reflux of food from the pouch into the esophagus. To correct the regurgitation, Paulino added the refinement of an isoperistaltic segment of jejunum between the esophagus and the jejunal pouch. Paulino reported excellent results in three patients. He sug-