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KMID : 0376219820190030327
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Chonnam Medical Journal
1982 Volume.19 No. 3 p.327 ~ p.333
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Esophagofundojejunostomy for diffuse gastric cancer
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Abstract
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Total gastrectomy is indicated for certain benign diseases such as ZollingerEllison syndrome and diffuse gastric erosion with uncontrollable bleeding, and such types of gastric malignancy as diffuse or proximal stomach cancer.
Postoperative complications following total gastrectomy are characterized by the higher incidence of suture line leakage, dumping syndrome, reflux esophagitis, decreased food capacity, and malnutrition compared to that of conventional subtotal gastrectomy. For a palliative purpose total gastrectomy has been regarded as contraindicated by some surgeons because of higher morbidity and mortality.
Various technical modifications have been tried in order to decrease these postoperative complications and sequelae.
A technical modification had been designed for the palliative and possibly curative surgery for the diffuse gastric cancer in which the cardia and the fundus were free of tumor. The fundus which is located higher than the cardia was left attached along with the distal esophagus after near-total gastrectomy and anastomosed to the jejunal ioop to decrease the anastomotic leakage and probably suture line stricture. The jejunal limb was composed of the food pouch of 9-shaped 30cm loop of the jejunum and the distal Rouxen-Y anastomosis. This loop appeared to decrease dumping and reflux esophagitis and increase the food capacity.
Three cases were reported, two for palliative and one for radical purpose with satisfactory results.
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