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Reconstruction after total gastrectomy: rationale for hunt lawrence j pouch reconstruction

Author: 
Shaukat Jeelani, Umer Mushtaq, Ishfaq Ahmad Gilkar, Javid Ahmad Peerzada and Varun Dogra
Subject Area: 
Health Sciences
Abstract: 

Background: The main categories of reconstruction following total gastrectomy are restoration of intestinal continuity without preservation of the duodenal food passage (Roux-en-Y oesophagojujunostomy) and restoration of intestinal continuity with preservation of the duodenal passage. Operations in either category may be combined with the construction of an enteric pouch or gastric reservoir to simulate the reservoir function of the normal, intact stomach. Methodology: The study included 20 patients, who underwent total gastrectomy with Hunt-Lawrence J–pouch reconstruction. In each patient postprandial symptoms, food intake in single meal (intake capacity),body weight, serum nutritional parameters viz. Serum total protein, serum albumin, serum cholesterol were evaluated. The follow up period was for 6 months and the patients were interviewed, examined periodically viz after 1 week of discharge from hospital, at the end of 1 month and at the end of 6 months. Results: The mean age of patients included in our study was 63 years. Postoperative follow up presented an improving trend in the mean haemoglobin values, 9.93±0.633 g/dl, 10.655±0.75 g/dl, 10.63±0.91 g/dl at the end of first week, first month and 6 months respectively. Preoperative mean serum albumin was 2.96±0.415 g/dl and post-operative mean serum albumin values were 2.51±0.566 g/dl, 2.835±0.752 g/dl, 3.24±0.392 g/dl at the end of first week, first month and 6 months respectively. The mean body weight preoperatively was 62.4±9.213 kilograms and the mean body weight ratio calculated on the follow up was 93.37±0.0388 %, 95.80±0.0313%, 97.95±0.0487% respectively. Conclusion: The findings of this study show that Hunt Lawrence reconstruction offers cancer patients an acceptable reconstructional method after total gastrectomy. The advantages of the pouch reconstruction: diminishing of postoperative symptoms, improvement in eating capacity, decreased postoperative weight loss and better postoperative nutrition.

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