New method for jejunal pouch interposition reconstruction after distal gastrectomy

Background/Aims: Recently pouch reconstruction has been reported to improve quality of life and functional results after surgery for gastric cancer. Although jejunal pouch reconstruction after distal gastrectomy has favorable results for patients' quality of life, it is complicated and takes a long time to complete. We developed a new technique using a linear stapling device to avoid this problem. Methodology: The duodenum and the jejunum are simultaneously divided with a 100-mm linear stapler 0.5cm distal to the pyrolus ring and 20cm distal to the ligament of Treitz, respectively. A 100mm linear stapler is introduced into two approximated segments of the jejunum through two small stab wounds 10cm and 15cm distal to the stump, respectively, and side-to-side anastomosis is performed along the antimesenteric borders. The anterior wall of the pouch is cut along the prospective line of anastomosis with the gastric remnant. The anterior wall of the stomach is cut along the planned suture line having a length similar to that of the pouch. The posterior walls of the stomach and the jejunal pouch are placed back-to-back on the planned anastomotic line. End-to-end posterior anastomosis between the gastric remnant and the jejunal pouch is simultaneously performed with gastrectomy using a 100-mm linear stapler. End-to-end anterior anastomosis is created by hand. Results: This technique has been used in 4 patients, and there have been no complications related to the pouch or anastomoses. Mean operative time was 255±37min (range: 205-290min). Conclusions: Shortening of operative time can be attributed to adoption of end-to-end posterior anastomosis between the stomach and the jejunal pouch using the linear stapling device simultaneously with gastrectomy.