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Restoration of gastrointestinal motility ameliorates nutritional deficiencies and body weight loss of patients who undergo laparoscopy-assisted proximal gastrectomy

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Abstract

Background

Esophagogastrostomy after proximal gastrectomy (PG) is a simple and safe reconstruction, but it leads to a high incidence of reflux esophagitis and impairs postoperative quality of life. We have already reported gastric tube (GT) reconstruction after PG and performed it on more than 100 patients. No studies have reported long-term outcomes after PG–GT. The aim of this study was to investigate long-term outcomes, including nutrition indices, such as body weight, serum albumin, total protein, hemoglobin, and ferritin after PG, and observe recovery of upper gastrointestinal tract motility.

Methods

We analyzed body weight loss and laboratory findings at our outpatient clinic at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Manometric recording was carried out at 1, 2, 3, 4, and 5 years after surgery.

Results

The percentage change in body weight in the PG–GT group was significantly larger than that in the PG–JI and TG–RY groups at 2.5, 3, 4, and 5 years after surgery. The levels of hemoglobin and ferritin in the PG–GT and PG–JI groups were significantly higher than those in the TG–RY group at all time points except 6 months after surgery. In the fasted state, the phase III originated at the gastric tube was propagated to the duodenum 3 years after surgery. In the fed state, phasic contractions of the duodenum were in harmony with gastric tube contractions 3 years after surgery.

Conclusions

PG–GT is the least invasive procedure, and restoration of gastrointestinal motilities in the gastric tube and duodenum may ameliorate body weight loss and nutritional status, including anemia, in patients after PG.

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Abbreviations

TG:

Total gastrectomy

EGC:

Early gastric cancer

PG:

Proximal gastrectomy

QOL:

Quality of life

GT:

Gastric tube

LAPG:

Laparoscopy-assisted proximal gastrectomy

JI:

Jejunal interposition

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Authors and Affiliations

  1. Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Yoshitaka Toyomasu, Kyoichi Ogata, Masaki Suzuki, Toru Yanoma, Akiharu Kimura, Norimichi Kogure, Mitsuhiro Yanai & Hiroyuki Kuwano

  2. Department of Surgery, Kajin-kai Chichibu Hospital, Chichibu, Saitama, Japan

    Tetsuro Ohno

  3. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan

    Erito Mochiki

Authors
  1. Yoshitaka Toyomasu
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  2. Kyoichi Ogata
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  3. Masaki Suzuki
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  4. Toru Yanoma
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  5. Akiharu Kimura
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  6. Norimichi Kogure
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  7. Mitsuhiro Yanai
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  8. Tetsuro Ohno
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  9. Erito Mochiki
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  10. Hiroyuki Kuwano
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Corresponding author

Correspondence to Yoshitaka Toyomasu.

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Disclosures

Drs. Yoshitaka Toyomasu, Kyoichi Ogata, Masaki Suzuki, Toru Yanoma, Akiharu Kimura, Norimichi Kogure, Mitsuhiro Yanai, Tetsuro Ohno, Erito Mochiki, and Hiroyuki Kuwano have no conflicts of interest or financial ties to disclose.

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Toyomasu, Y., Ogata, K., Suzuki, M. et al. Restoration of gastrointestinal motility ameliorates nutritional deficiencies and body weight loss of patients who undergo laparoscopy-assisted proximal gastrectomy. Surg Endosc 31, 1393–1401 (2017). https://doi.org/10.1007/s00464-016-5127-z

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  • DOI: https://doi.org/10.1007/s00464-016-5127-z

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