Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2015 May;100(5):954-7.
doi: 10.9738/INTSURG-D-14-00181.1.

A long-term follow-up result of pouch plasty for severe dysfunction of jejunal pouch reconstruction after total gastrectomy: a case report

Takafumi Tamura  1 , Satoshi Inagawa, Hideo Terashima, Yoshimasa Akashi, Katsuji Hisakura, Tsuyoshi Enomoto, Nobuhiro Ohkohchi
Affiliations
Case Reports

A long-term follow-up result of pouch plasty for severe dysfunction of jejunal pouch reconstruction after total gastrectomy: a case report

Takafumi Tamura et al. Int Surg. 2015 May.

Abstract

A 78-year-old woman with malignant lymphoma of the stomach underwent total gastrectomy with a jejunal-pouch (J-pouch) reconstruction in 1994. Twelve years after surgery the patient began to suffer epigastric distress and reflux symptoms. Eventually, she was unable to take anything by mouth. A series of diagnostic images seemed to indicate that the main cause of the dysfunction was flaccidity of the J-pouch and deformity of the outflow route induced by chronic excessive dilatation of the pouch wall. Because all conservative managements only led to temporary improvement and ended in failure, she hoped to receive the operation. We designed "pouch plasty" capable of ameliorating the pouch dysfunction. The aim of pouch plasty was to improve uneven tension of the pouch wall and repair deformity of the outflow route of the food. After the operation, the J-pouch resumed adequate drainage and had good reservoir function. More than 7 years later, the patient had no further complications.

Keywords: Delayed emptying; Gastrectomy; Jejunal pouch reconstruction; Pouch plasty.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Abdominal computed tomography (CT) before and after the secondary operation, “pouch plasty.” (A) Abdominal CT showed severe dilatation of the jejunal pouch with a huge amount of food residue. (B) Abdominal CT showed the adequate capacity of the J-pouch at 7 years after the secondary operation.
Fig. 2
Fig. 2
Gastrointestinal fluoroscopy before and after the secondary operation, “pouch plasty.” (A) Preoperative gastrointestinal fluoroscopy showed atonic dilatation of the J-pouch and obstruction of the passage of food. (B) Postoperative gastrointestinal fluoroscopy showed smooth passage of water-soluble contrast material, and there was no flabby part in the J-pouch.
Fig. 3
Fig. 3
Operative procedure of pouch plasty. (A) Pouch plasty was designed so that there was no flabby wall and the outflow route was changed linearly in the direction of the vent. (B) The flabby wall was resected with a linear stapler, and the staple line was buried using interrupted seromuscular sutures.
Fig. 4
Fig. 4
Histopathologic examination of the partially resected pouch wall showed the preservation of almost normal histologic structure in the muscular coat proper. Fontana-Masson stain (×20).
See this image and copyright information in PMC

References

    1. Nakane Y, Akehira K, Okumura S, Okamura S, Boku T, Okusa T, et al. Jejunal pouch and interposition reconstruction after total gastrectomy for cancer. Surg Today. 1997;27(8):696–701. - PubMed
    1. Miyoshi K, Fuchimoto S, Ohsaki T, Sakata T, Takeda I, Takahashi K, et al. Evaluation of Jejunal pouch reconstruction after total gastrectomy. Jpn J Gastroenterol Surg. 2000;33(4):427–432.
    1. Adachi S, Inagawa S, Enomoto T, Shinozaki E, Oda T, Kawamoto T. Subjective and functional results after total gastrectomy: perspective study for longterm comparison of reconstruction procedures. Gastric Cancer. 2003;6(1):24–29. - PubMed
    1. Takeshita K, Sekita Y, Medium- Tani M. and long-term results of jejunal pouch reconstruction after a total and proximal gastrectomy. Surg Today. 2007;37(9):754–761. - PubMed
    1. Tono C, Terashima M, Takagane A, Abe K. Ideal reconstruction after total gastrectomy by the interposition of a jejunal pouch considered by emptying time. World J Surg. 2003;27(10):1113–1118. - PubMed

Publication types

LinkOut - more resources