Abstracts
1998 Digestive Disease Week

#974

CLINICAL OUTCOME AND QUALITY OF LIFE AFTER GASTRIC AND DISTAL ESOPHAGUS REPLACEMENT WITH AN ILEOCOLON INTERPOSITION. J.Metzger1), M. von Flüe2), L. Degen3), Ch. Beglinger3) and F. Harder1). 1)Department of Surgery and 3)Department of Gastroenterology, University Hospital. Basel. Switzerland. 2)Department of Surgery, Canton Hospital. Luzern. Switzerland.

We evaluated an ileocolon segment as a substitute stomach after total gastrectomy and distal esophagectomy to overcome postgastrectomy problems. This pedunculated ileocecal interpositional graft rotated 180° clockwise and placed between the proximal esophagus and the duodenum could act as a reservoir and protect against reflux (ileocecal valve) while preserving the duodenal passage. Methods: In this clinical study, an ileocolon interposition was performed in 8 patients who underwent total gastrectomy and in 5 patients who underwent total gastrectomy and distal esophagectomy for malignant gastric or cardia lesions. The function of this substitute was evaluated using weight development, clinical assessment, gastrointestinal quality of life index (Eypasch score), gastric emptying studies and esophagoscopy. Results: There were no cases of operative death. One patient (1/13) developed a pancreatic fistula and an anastomotic leakage of the esophageoileostomy. No patient reported dumping syndrome. One patient complained of reflux symptoms. Patients continued to gain weight usually from the 10th postoperative week on. Endoscopy did not reveal any signs of esophagitis or reflux in any patients. Six months after the operation, patients answered the quality of life index questionnaire and reached 106 points in average (score: 0-144 points). Conclusions: This method combines the advantages of sufficient antireflux barrier, preserving the duodenal passage and an adequate neogastric reservoir. It can be used safely and seems to have advantages compared to the standard reconstruction procedures such as the Roux-en-Y esophagojejunostomy and the various jejunal pouch techniques.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.