The nutrition after gastrectomy

Abstract

Aim: We evaluate the results of the reconstruction of the upper part of gastrointestinal tract after total gastrectomy in two groups of the patiens. The reconstruction with creation of “J“ pouch was performed in the first group. The Roux-en-Y reconstruction was performed in the second group. Material and method: This trial has a prospective randomized design. 84 patients underwent the total gastrectomy for advanced gastric cancer in the period from February 1999 to December 2004. We compare the group of 43 patients with the reconstruction of the digestive tract with “J“ pouch and the group of 41 with the Roux-en-Y reconstruction. The follow-up is realized at the gastroenterosurgical ambulatory. We have cooperated with radiotherapeutical clinic and with oncological register. The survival is one of the parameters that has been observed. We evaluate nutritional state of patients. We evaluate BMI and biochemical nutritional parameters as follows: total protein, albumin, cholesterol, HDL, LDL, TAG, transferrin, prealbumin, orosomucoid and cholinesterasis. We evaluate the quality of life using Gastrointestinal Quality of Life Index (GLQI) according to Eypasch. We evaluate the evacuation of the upper part of GI tract after the reconstruction by dynamic scintigraphy using radioisotop 99mTc. Results: BMI in the group with “J“ pouch reconstruction was 87.8% 3 months after surgery in the relation to the BMI value before diagnosis of malignancy and 90.5% 12 months after surgery. BMI was 82.4% 3 months after surgery and 83.7% 12 months after surgery in the group with the Roux-en-Y reconstruction. We compare this results using statistical method of correlation coefficient. The results of this comparison speak in favor of “J“ pouch reconstruction. We evaluate the biochemical parameters, too. For the comparison the Student T-test is used. When evaluating, 3 months after the surgery there was only one difference. There was a lower value of cholesterol in the group with “J“ pouch reconstruction (p=0.05). Other parameters were without statistically significant differences (p=0.05). 12 months after surgery all measured parameters were without statistically significant difference (p=0.05). The evacuation of upper gastrointestinal part after reconstruction measured by dynamic scintigraphy is in the “J“ pouch group 89.4 minutes and in the Roux-en-Y group 16.4 minutes. Conclusion: According to our results, the substitution of the „J“ pouch is an advisable type of surgery for the reconstruction of the digestive tract after total gastrectomy. The nutritional state is better and the quality of life is higher. In the case of necessity of the total gastrectomy, it is important to choose a type of reconstruction, which can meet the requirements of keeping the duodenum in the passage and the substitution of the stomach volume.