This article is more than 5 years old. Information may no longer be current.
Pouch creation after gastrectomy improves functional, nutritional outcomes
Click Here to Manage Email Alerts
Patients who underwent pouch creation after total gastrectomy experienced better long-term functional and nutritional outcomes without any added risk for perioperative morbidity, according to research published in the Annals of Surgery.
“Total gastrectomy is a very common surgical procedure for treating gastric malignancies, especially those involving the proximal stomach,” Nicholas L. Syn, of the department of surgery at the Yong Loo Lin School of Medicine at the National University of Singapore, told Healio Gastroenterology and Liver Disease. “Roux-en-Y reconstruction and jejunal interposition are espoused by international guidelines as the ‘gold standard’ for restoration of the alimentary tract. Unfortunately, these techniques are associated with high rates of post-prandial symptoms such as dumping syndrome, heartburn/esophagitis and malnutrition.”
Syn said the construction of a pouch can serve as a “stomach substitute” and recreates some of the functions of the stomach, limiting postoperative complications.
To assess the impact of pouch creation, investigators searched the literature for randomized and non-randomized studies that compared reconstruction with and without a pouch. They identified 17 randomized controlled trials and eight observational studies comprising 1,621 participants that met their criteria.
Syn and colleagues found that 1 to 2 years after surgery pouch creation resulted in a reduction in the rate of esophagitis/heartburn (63% relative reduction) and food intake disturbance (50% relative reduction). It also offered a reduction in the risk for dumping syndrome at 3 to 6 months (8.1% vs. 32.4%; RR = 0.36; 95% CI, 0.21–0.6) and at 12 to 24 months after surgery (2.8% vs. 23.6%; RR = 0.27; 95% CI, 0.16–0.46). Patients that underwent pouch creation also experienced improvement in BMI, serum albumin and quality of life after surgery.
Additionally, investigators found that pouch creation did not increase perioperative risks, such as abdominal abscess and anastomotic leak. However, it was associated with an increase in operation time (weight mean difference 23.5 minutes; 95% CI, 9.8–37.2).
Syn said their findings show that pouch creation could be beneficial for patients who undergo total gastrectomy.
“The construction of a pouch after total gastrectomy for gastric malignancy markedly reduces post-operative side effects and improves quality-of-life outcomes in the long-term, without incurring greater perioperative risks,” he said. – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
Click Here to Manage Email Alerts