Optimal gastric pouch reconstruction post-gastrectomy

Shayanthan Nanthakumaran, S. A. Suttie, Howard W. Chandler, Kenneth G. M. Park

    Research output: Contribution to journalArticlepeer-review

    2 Citations (Scopus)

    Abstract

    Background. Gastric pouches have the potential to improve nutrition following total gastrectomy, compared with standard reconstruction. However, a consensus view of clinical benefit is not available, at least partly due to a lack of standardization of pouch design or size. This study was undertaken to identify optimal conditions for pouch design. Methods. A mathematical model was established and a porcine model constructed to evaluate the pressure/volume dynamics of the pouch. A "J" pouch was constructed at anastomotic lengths of 5, 10, 15, and 20 cm. Each pouch was distended with saline and the pressure/volume relationship established. Results. Mathematically, increasing the anastomotic length of the pouch to 15 cm increases the volume significantly; thereafter, there is minimal benefit of increasing the pouch length further. For smaller pouches (5 and 10 cm) a 350-to 400-ml volume (approximate meal volume in the elderly) is never achieved until higher pressures (45 cmH O) are applied. However, in the larger pouches (15 and 20 cm) a 350-to 400-ml volume is readily achieved at basal pressures of 15 cmH O. Conclusion. Smaller pouches never achieve adequate volumes at basal pressures; accordingly, it is unlikely that they will lead to any clinical benefit. Further in-vivo studies should therefore be based upon 15-cm pouch designs.
    Original languageEnglish
    Pages (from-to)33-36
    Number of pages4
    JournalGastric Cancer
    Volume11
    Issue number1
    DOIs
    Publication statusPublished - 1 Mar 2008

    Keywords

    • Gastric cancer
    • Total gastrectomy
    • Gastric pouch
    • Reconstruction
    • Mathematical modeling

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