Optimal size of jejunal pouch as a reservoir after total gastrectomy: a single-center prospective randomized study.

Tsujimoto, Hironori; Sakamoto, Naoko; Ichikura, Takashi; Hiraki, Shuichi; Yaguchi, Yoshihisa; Kumano, Isao; Matsumoto, Yusuke; Yoshida, Kazumichi; Ono, Satoshi; Yamamoto, Junji; Hase, Kazuo

BACKGROUND In order to improve a patient's quality of life after total gastrectomy, jejunal pouch reconstruction has been employed. However, little information exists regarding the optimal size of the jejunal pouch after total gastrectomy. METHODS The study was designed as a single-center randomized trial in which the results of double-tract reconstruction with pouches of two different sizes were compared, i.e., short and long pouch double tract (SPDT and LPDT, respectively). We conducted a clinical assessment with standard questionnaire after surgery. The amount of residual food in the jejunal pouch was determined by endoscopy. RESULTS No demographic differences were noted between the two groups. The eating capacity per meal was higher in the SPDT group than in the LPDT group. The postoperative weight loss 24 months after surgery was lower in SPDT group than that in the LPDT group. Although the incidence of early dumping symptoms was higher in the SPDT group, no difference was noted in the other postprandial abdominal symptoms between the two groups. CONCLUSIONS We conclude that the optimal pouch should be relatively short, as a short pouch improves the eating capacity per meal and the weight loss ratio to the preoperative value.