Emptying of the jejunal pouch and Roux-en-Y limb after total gastrectomy - a randomised, prospective study

Objective: To investigate the emptying of solids after total gastrectomy with pouch reconstruction. Design: Randomised, prospective study. Setting: University hospital, Finland. Subjects: 49 patients with gastric carcinoma operated on for cure between 1988 and 1992. Interventions: After total gastectomy 26 patients were randomised to have a pouch reconstruction and 23 a Roux-en-Y reconstruction. 15 months after the operation 24 patients with a pouch (pouch group) and 21 patients with a simple Roux-en-Y reconstruction (Roux-en-Y group) were alive and available to have an emptying test by the solid isotope method. Emptying of the pouch and Roux-en-Y limb was assessed by measuring the activity at 3 hours. Main outcome measures: postoperative symptoms, size of meal, and postoperative nutrition. Results: Emptying was significantly slower after pouch reconstruction than after Roux-en-Y (mean activity at 3 hours 82% and 44%, respectively, p < 0.01). Early satiety occurred in 10 (48%) of the patients after Roux-en-Y reconstruction and 6 (25%) in the pouch group. Dumping was more common in the Roux-en-Y group (n = 12, 57% compared with n = 6, 25%, p = 0.04). 19 (79%) of the patients in the pouch group were able to eat normal sized meals compared with 3 (14%) in the Roux-en-Y group (p < 0.0001). Weight gain and haemoglobin and albumin concentrations were similar in the two groups. Conclusion: Jejunal pouch reconstruction after total gastrectomy delays passage of solid food in the upper intestine compared with Roux-en-Y reconstruction. it is associated with better eating capacity and fewer postoperative symptoms.