ROUX-EN-Y ESOPHAGOJEJUNOSTOMY AFTER TOTAL GASTRECTOMY FOR GASTRICMALIGNANCY.
Hashim S Khayat# & Safwan A Taha*
*CABS. Professor, Dept. of Surgery, University of Basrah, College of Medicine; #FRCS Ed. Consultant Surgeon and Chairman, Basrah General Hospital, Basrah; IRAQ.
Out of 62 patients who underwent total gastrectomy for gastric malignancy, 40 patients had roux-en-y esophagojejunostomy. Their age ranged from 32 to 70 years. Seventeen patients were less than 60 years old and 27 were older. There were 23 males and 17 females. Operations were done through thoraco-abdominal incisions in 28 patients and upper midline incisions in 12. The anastomoses, on the other hand, were hand sewn in 34 patients and stapled in the other 6. The procedure included splenectomy in 37 patients, distal pancreatectomy in 6 and transverse colectomy in 2 patients. Postoperative complications included chest infection (8 patients), wound infection (7 patients) and anastomotic leak (1 patient). Eleven patients died postoperatively, the leading cause being pulmonary embolism, respiratory failure and over-whelming sepsis. Out of our surviving patients, 4 (10%) are still alive 5 years or more after surgery and are enjoying good health. Our results are well within the international figures although we think that the outlook could have improved had we gained access to certain facilities like hyperalimentation, chest physiotherapy units and measures that could prevent deep venous thrombosis. Roux-en-y esophagojejunostomy is a safe method to restore the continuity of the alimentary tract after gastrectomy. It requires less time than “pouch-forming” procedures, has less incidence of anastomotic leakage, produces acceptable morbidity and mortality, gives good nutritional value and does not require the special expertise needed to perform the “pouch-forming” procedures.