The postoperative courses of 99 cases of Plenk reconstruction after total gastrectomy were compared with those of 97 cases of Roux-en-Y reconstruction performed at the Department of Surgry, Kyungpook National University Hospital during the five
year
period of 1988 through 1992.
The morbidity and mortality were 20.2% and 1.0% after Plenk reconstruction and 18.6% and 3.1% after Roux-en-Y reconstruction.
Fifty four patients(54.5%) complained of symptoms of reflux esophagitis after Plenk reconstruction and 11 patients(11.3%) after Roux-en-Y reconstruction(p<0.001) during the follow-up period of 6 to 36 months. Among 54 patients with reflux
esophagitis
after Plenk reconstruction, 24 patients complained the symptoms such as substernal pain, regurgitation of bile within 1 month postopratively, 16 patients between 1 and 2 months, 6 between 2 and 3 months, and 8 after three months postoperatively.
There were mild symptoms of reflux esophagitis after 12 months in Roux-en-Y group, but 24. 1% of the patients complained moderate to severe symptoms at 18 months, 21.4% at 24 months after Plenk reconstruction.
Weight loss was fount in 40.8% of cases after Plenk reconstruction and 3.7% after Roux-en-Y reconstruction 6 months postoperatively, 40% and 6.7% respectively 12 months postoperatively.
Passage of contrast media through the previously ligated afferent jejunal loop was identified in 44.8% of cases after Plenk reconstruction. Mild degree of esophagitis was found on endoscopic examination in 29.0% of the cases after Plenk
reconstruction,
moderate degree of esophagitis in 16.1%, severe in 19.4%.
Revision of Plenk reconstruction to Roux-en-Y reconstruction was performed in 6 cases(6.1%) who had severe symptoms of reflux esophagitis for more than one year and revealed passage of contrast media thorough the recanalized afferent jejunal loop
on
radiologic study, and the symptoms were subsided after revision.
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