Evaluation of the digestive function in patients after gastrectomy with its jejunogastroplasty (interim results)

Introduction. In order to prevent severe digestive disorders after gastrectomy, more than 70 options for restoring the digestive tract have been proposed, but there is no single method of choice, as there are no studies proving the advantage of one or another method of reconstruction.

Aim: To study the digestive function in patients after gastrectomy with jejuna gastroplasty (JGP), by comparative analysis with a standard Roux-en-Y.

Materials and methods of research. A comprehensive examination of 64 patients who underwent gastrectomy at the Vishnevsky National Medical Research Center of Surgery was conducted at the Federal Research Centre of Nutrition and Biotechnology. Depending on the variant of reconstruction of the digestive tract, patients are divided into 2 groups: JGP (main) – 41 (64,1%) patients, and the Roux-en-Y (control) – 23 (35,9 %).

Results. When examining complaints, it was revealed that patients in the JGP group have a lower degree of abdominal pain, bloating, nausea, bitterness and dry mouth. Impaired absorption of fatty acids (p=0,04) and the soaps formed from them (p= 0,01) are more common in the control group. Quality of life indicators are higher in the JGP group: physical health (55,5±23,9 vs. 46,4±17,7; p=0,03), mental health (59,3±23,2 vs. 52,4±15,6, ns), integral quality of life (58,1±24,3 vs. 49,2±17,0; p=0,008)

Conclusion. Preliminary results of the study of the nutritional status of patients after gastrectomy with JGP indicate a more active intestinal absorption, a lower severity of dyspeptic disorders and better quality of life than in patients with Roux-en-Y.

1. Besova N.S., Titova T.A., Artamonova E.V., Tryakin A.A., Stroyakovsky D.L., Perminova E.V., Yukalchuk D.Yu., Ponomarenko D.M., Belyak N.P., Orlova R.V., Teletaeva G.M., Ratner E.Yu., Mochalova A.S., Gordeeva O.O., Zhabina A.S., Gamayunov S.V., Smolin A.V., Povyshev A.Yu., Andrievskikh M.I., Stilidi I.S. Analysis of prognostic factors for survival in the Russian population of patients with disseminated gastric cancer who received ramucirumab in the second line of treatment in the RAMSELGA study. Medical Council, 2020, № 9, pp.165–174. https://doi.org/10.21518/2079-701X-2020-9-165-174 (in Russ.)

2. Polikarpov S.A., Lisitsky I.V., Goryunov I.V., Suleymanov M.U. The choice of the method of applying esophageal-intestinal anastomosis after gastrectomy. Surgery. The magazine named after N.I. Pirogov, 2008, № 9, pp. 56–60. (In Russ.)

3. Naum C., Bîrlă R., Marica D.c., Constantinoiu S. In Search of the Optimal Reconstruction Method after Total Gastrectomy. Is Roux-en-Y the Best? A Review of the Randomized Clinical Trials. Chirurgia (Bucur), 2020, Jan-Feb; № 115(1), pp. 12–22. https://doi.org/10.21614/chirurgia.115.1.12 (in Russ.)

4. Nenarokomov A.Yu., Speransky D.L., Arevshatov E.V., Mudry A.Yu. Modern concept of quality of life research in oncology. Fundamental Research, 2012, № 2–2, pp. 421–425. URL: https://fundamental-research.ru/ru/article/view?id=29549 (date of application: 06/22/2023). (In Russ.)

5. Khomichuk A.L. Dynamics of clinical and metabolic parameters in patients after gastrectomy in the process of personalized diet therapy with the inclusion of enteral nutrition. Russian Medical Journal, 2013, № 5, pp. 19–23. (In Russ.)

6. Henderson, J.M. Pathophysiology of the digestive organs. St. Petersburg: BINOM, 1999, 286 p. (In Russ.)

7. Korotko G.F. The duodenum plays a key role in the digestive pipeline. Complicated forms of duodenal ulcer. Krasnodar, 2004, pp. 40–49. (In Russ.)

8. Avdeev V.G. Clinical manifestations, diagnosis and treatment of disorders of motor function of the duodenum. Russian Journal of gastroenterology, hepatol, coloproctol, 1997, № 5, pp. 8–88. (In Russ.)

9. Popov V.A. Membrane digestion in surgical pathology. M.: Med, 1982, 191 p. (In Russ.)

10. Zhang, J.Z. Lu H.S., Wu X.Y. et al. Influence of different procedures of alimentary tract reconstruction after total gastrectomy for gastric cancer on the nutrition and metabolism of patients: a prospective clinical study. Zhonghua yi xue za zhi., 2003, Т. 83, № 17, рр. 1475–1478.

11. Iwahashi M., Nakamori M., Nakamura M., et al. Evaluation of double tract reconstruction after total gastrectomy in patients with gastric cancer: prospective randomized controlled trial. World journal of surgery, 2009, Т. 33, № 9, рр. 1882–1888.

12. Yang Y.S., Chen L.Q., Yan X.X. et al. Preservation versus Nonpreservation of the Duodenal Passage Following Total Gastrectomy: A Systematic Review. Journal of Gastrointestinal Surgery, 2013, Т. 17, № 5, рр. 877–886.

13. Zherlov G., Koshel A., Orlova Y. et al. New type of jejunal interposition method after gastrectomy. World journal of surgery, 2006, Т. 30. № 8, рр. 1475–1480.

14. Ishigami S., Natsugoe S., Hokita S. et al. Postoperative long-term evaluation of interposition reconstruction compared with Roux-en-Y after total gastrectomy in gastric cancer: prospective randomized controlled trial. The American Journal of Surgery, 2011, Т. 202, № 3, рр. 247–253.

15. Uvarov I.B. Osipovich O.M. Derbenev S.N. Comparative evaluation of reconstruction methods after gastrectomy with and without preservation of the duodenal passage in patients with gastric cancer: a systematic review and meta-analysis. Kuban Scientific Medical Bulletin, 2022, № 29 (2), pp. 58–78. (In Russ.)