[A new reconstruction procedure as antireflux surgery after proximal gastrectomy. Interposition of the jejunal pouch with valvuloplasty].

In order to reduce the incidence of reflux esophagitis following proximal gastrectomy, we have developed a new reconstruction procedure with an interposed jejunal pouch with antireflux valvuloplasty between the esophagus and the gastric remnant. After a standard proximal gastrectomy and lymph node dissection, the jejunum is divided at a point 25 cm from the Treitz ligament. The distal jejunum is pulled up through the transverse mesocolon with a mesenterium and anastomosed to the esophagus with a PCEEA stapling device. The pulled through jejunum is doubled up at a point 30 cm from the esophagojejunostomy, and the 5 cm tip of the jejunum is resected. A 5.5 cm autosuture GIA is inserted into the jejunum from both cut ends of the jejunum for side-to-side anastomosis on the antimesenteric side to make a 5 cm long jejunal pouch, and the jejunum is further divided 5 cm distal from the jejunal pouch. As a result, the interposed jejunal segment is omponed of a single-lumen 15 cm jejunum, a parallel lumen 5 cm jejunum, and a double-lumen jejunum. In the double-lumen jejunum, the jejunal pouch plays the role of a pressure absorber in the residual stomach, and the septum of the parallel lumen jejunum that of an anti-reflux valve. Peristalsis of the single lumen 15 cm jejunum prevents reflux to the esophagus. Postoperative examinations showed that this reconstruction method has satisfactory to excellent results.