The European journal of surgery = Acta chirurgica · 1998
Nutritional state, growth rate, and morphology after total gastrectomy with restoration of duodenal passage or Roux-en-Y oesophagojejunostomy with or without a pouch: an experimental study in pigs.
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Zilling T, Hansson L, Willén R, Sternby B
Аннотация
OBJECTIVE: To compare the effect of restoration of duodenal continuity by a Roux-en-Y oesophagojejunostomy with or without a pouch on nutritional state, growth, and morphology after total gastrectomy in pigs.
DESIGN: Experimental study.
SETTING: Teaching hospital, Sweden.
MATERIAL: 60 Swedish domestic pigs.
INTERVENTIONS: 54 pigs underwent total gastrectomy and 6 had sham operations. 20 pigs had reconstruction by a Roux-en-Y oesophagojejunostomy, 21 had a jejunal loop interposed between the oesophagus and the duodenum, as 13 had a oesophagojejunostomy with jejunal pouch on a Roux-en-Y loop.
MAIN OUTCOME MEASURES: Weight, laboratory indicators of nutritional state, and histological appearance of the gut.
RESULTS: Growth was significantly retarded in those pigs that had had gastrectomies (p < 0.001) but there were no differences among the experimental groups. Haemoglobin, albumin, and calcium concentrations were significantly lower in the experimental groups than in the control group (p=0.006, 0.02, and 0.002, respectively). Histological examination showed subtotal villous atrophy in the experimental groups, most obvious in the pouch group. Colonic mucosal height was reduced in the experimental groups.
CONCLUSION: This study failed to show any advantage in growth rate when restoration of duodenal continuity or a small bowel pouch were compared with a conventional Roux-en-Y oesophagojejunostomy after total gastrectomy. However, restored duodenal passage seemed to benefit calcium homeostasis.
DESIGN: Experimental study.
SETTING: Teaching hospital, Sweden.
MATERIAL: 60 Swedish domestic pigs.
INTERVENTIONS: 54 pigs underwent total gastrectomy and 6 had sham operations. 20 pigs had reconstruction by a Roux-en-Y oesophagojejunostomy, 21 had a jejunal loop interposed between the oesophagus and the duodenum, as 13 had a oesophagojejunostomy with jejunal pouch on a Roux-en-Y loop.
MAIN OUTCOME MEASURES: Weight, laboratory indicators of nutritional state, and histological appearance of the gut.
RESULTS: Growth was significantly retarded in those pigs that had had gastrectomies (p < 0.001) but there were no differences among the experimental groups. Haemoglobin, albumin, and calcium concentrations were significantly lower in the experimental groups than in the control group (p=0.006, 0.02, and 0.002, respectively). Histological examination showed subtotal villous atrophy in the experimental groups, most obvious in the pouch group. Colonic mucosal height was reduced in the experimental groups.
CONCLUSION: This study failed to show any advantage in growth rate when restoration of duodenal continuity or a small bowel pouch were compared with a conventional Roux-en-Y oesophagojejunostomy after total gastrectomy. However, restored duodenal passage seemed to benefit calcium homeostasis.