Abstract
Among patients who underwent total gastrectomy for gastric cancer, 102 patients who received transverse colon interposition (TCI) by the Nagamachi type II method, (48 manual and 54 mechanical) were compared with 24 patients who underwent the jejunal ρ-loop Roux en Y method. Esophageal reflux was compared between the above three methods, and the influence on the quality of life (QOL) was examined. When compared to the jejunal ρ-loop Roux en Y method, the QOL was better for patients who underwent the TCI method (p<0.01). The incidence of reflux esophagitis with the TCI method was lower than after the jejunal ρ-loop Roux en Y method (p<0.05), and was 0% for the manual method. Reflux prevention was assessed using the standard acid reflux test and the degree of esophageal reflux with the manual method was significantly lower than with the jejunal ρ-loop Roux en Y method (p<0.0001). Esophageal reflux was also less severe with the manual method than the mechanical method (p<0.05). Manometry of the replacement stomachs revealed that, even though retrograde contraction waves were not detected in the interposed colon, the high pressure zone at the esophago-interposed colonic junction played a role in preventing reflux. These findings indicate that the TCI method particularly by the manual method is a good reconstruction technique after total gastrectomy. Excellent postoperative QOL can be obtained soon after the operation, because reflux esophagitis can be almost completely prevented.
