Abstract
In 1951, Hunt devised a new method of reconstruction after total gastrectomy by combining Steinberg's pantaloon procedure with Roux-Y procedure. In this method, after the stomach is removed and the duodenal stump is closed, the jejunum is divided between clamps about 30 to 35 cm below the ligament of Treitz. The distal limb of the jejunum is brought up anterior to the colon, and the end is doubled back upon itself in a side-to-side manner for about 15cm. The sides of these loops are sutured together, an anastomosis with a full-length stoma is made, and the transacted end of the jejunum is incorporated in the anastomosis. This forms a large pouch, which is then anastomosed to the esophagus by interrupted suture.
After that, Kalemba, with his procedure modified by the introduction of the technique of fundoplication, obtained favorable results. We tried to perform Hunt's reconstruction in 34 patients, and conducted Kalemba's procedure in 17 patients.
The following operative results were obtained. There were no operative deaths, although three patients died during hospitalization (late death), postoperative complication included leakage of the anastomosis in four patients and intraperitoneal abscess in five patients, all of which, however, were cured by conservative treatment.
Reflux esophagitis occurred in two patients, one of whom required surgical procedure for stricture of the anastomosis. These two patients underwent the original procedure of Hunt. The modified Kalemba procedure did not induce reflex esophagitis.
The patients who lived for a longer period were relatively well nourished, but some of them developed vitamin B12 deficiency within a long-term follow-up period. Therefore, it was necessary to give vitamin B12 in these patients.
The overall cumulative 5-year-survival rate in the patients receiving the above procedures was 34.9 percent. Although this procedure of reconstruction needs complicated procedure, the application of an autosuture instrument solved the problem. Thus, this procedure is considered useful for such patients.
