Jejunogastroplasty as an alternative to traditional reconstruction of the digestive tract after gastrectomy

• Ruchkin D.V.
• Kozlov V.A.
• Rymar O.A.
• Nitkin A.A.
• Nazariev P.I.

Abstract

Aim. To prove the safety of jejunogastroplasty as a method of physiological reconstruction of the upper digestive tract after gastrectomy.

Material and methods. The analysis of the immediate results of treatment of 295 patients who underwent gastrectomy for a malignant tumor of the stomach in the Department of reconstructive surgery of the esophagus and stomach of the National Medical Research Center for Surgery named after A.V. Vishnevsky within the period 2011–2022. 2 groups were compared prospectively: Roux-en-Y (control) – 78 (26.4%) and jejunogastroplasty (JGP) (main) – 217 (72.6%), which, depending on the options, was divided into 3 more subgroups: standard – 104 (47.9%), valve – 78 (35.9%) and the pouch – 35 (16.2%). Thus, a comparative assessment was carried out not only between the two groups of JGP and Roux-en-Y, but also between 3 subgroups, comparing the results in them with the control group.

Results. The duration of the operation in the main group was significantly longer by 44 min than in the control group (p=0.001), the pouch of the JGP lengthens the operation by another 30 min., compared with the standard (p=0.0236) and valve (p=0.0480). The duration of the postoperative period in the Roux-en-Y group was 12.8±8.3 days, for the JGP group 12.6±10.5 (p=0.0396). Statistical differences were revealed only when comparing the valve JGP (13.3±10.5) and the pouch EGP (9.5±4.9) (p=0.0532). The incidence of complications in the main group was 24 (11.1%), whereas in the Roux-en-Y – 14 (17.9%) (p=0.147). According to the Clavien–Dindo classification, there were no statistical differences in the severity of complications between the groups: III degree – p=0.361 and IV degree – p=0.522. According to this criterion, groups with different variants of JGP did not differ either. Postoperative mortality was 4 (1.3%) patients, two in each group – Roux-en-Y and JGP (p=0.389).

Conclusion. The immediate results of jejunogastroplasty in Vishnevsky National Medical Research Center allow us to consider it a safe and completely reproducible surgical technique, which can be considered as an alternative to traditional methods of reconstruction after gastrectomy.

Keywords:jejunogastroplasty; gastric cancer; gastrectomy; Roux-en-Y

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