**Operation**

**Chapter 1**

**Provisional chapter**

**Reconstructive Procedures after Total Gastrectomy for**

**Reconstructive Procedures after Total Gastrectomy for** 

Till this day, there are more than 60 described surgical procedures of the intestinal reconstructions after a total gastrectomy. In 1897, Schlatter reconstructed the digestive tract by creating a termino-lateral esophagojejunostomies that was the first successful total gastrectomy. Many of the total gastrectomy pioneers did the reconstruction by esophagoduodenostomy or by forming a loop esophagojejunostomy. The main reconstruction modalities after a total gastrectomy are a restitution of the intestinal continuity, without a preservation of the duodenal food passage (esophagojejunostomy with a Roux-en-Y configuration) and a restitution of the intestinal continuity with a preservation of the duodenal passage (esophagojejunostomy with Roux-en-Y configuration and forming of the lateral-terminal jejunoduodenal anastomosis double tract and jejunal interposition by Longmire). The surgeries in these categories can be combined with forming of an enteral pouch or a stomach reservoir which would simulate a reservoir of a normal intact stomach. The ideal reconstruction procedure after total gastrectomy should replace all lost functions of the stomach. Preservation of duodenal transit with replacement of the jejunal segment, the so-called physiological route, is now believed to be preferential for postoperative nutritional condition, prevents persistent postgastrectomy syndrome, and improves the quality of life. Reconstructive procedures which allow duodenal passage

**Keywords:** gastric cancer, total gastrectomy, reconstructive procedures, nutritive status,

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.5772/intechopen.75591

**Gastric Cancer**

**Gastric Cancer**

Miodrag N. Djordjevic

Miodrag N. Djordjevic

**Abstract**

quality of life

Nebojsa S. Ignjatovic, Tomislav D. Randjelovic, Miroslav P. Stojanovic, Goran Z. Stanojevic and

Nebojsa S. Ignjatovic, Tomislav D. Randjelovic, Miroslav P. Stojanovic, Goran Z. Stanojevic and

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

should be regarded as a key to physiological reconstruction.

http://dx.doi.org/10.5772/intechopen.75591

#### **Reconstructive Procedures after Total Gastrectomy for Gastric Cancer Reconstructive Procedures after Total Gastrectomy for Gastric Cancer**

DOI: 10.5772/intechopen.75591

Nebojsa S. Ignjatovic, Tomislav D. Randjelovic, Miroslav P. Stojanovic, Goran Z. Stanojevic and Miodrag N. Djordjevic Nebojsa S. Ignjatovic, Tomislav D. Randjelovic, Miroslav P. Stojanovic, Goran Z. Stanojevic and Miodrag N. Djordjevic

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.75591

#### **Abstract**

Till this day, there are more than 60 described surgical procedures of the intestinal reconstructions after a total gastrectomy. In 1897, Schlatter reconstructed the digestive tract by creating a termino-lateral esophagojejunostomies that was the first successful total gastrectomy. Many of the total gastrectomy pioneers did the reconstruction by esophagoduodenostomy or by forming a loop esophagojejunostomy. The main reconstruction modalities after a total gastrectomy are a restitution of the intestinal continuity, without a preservation of the duodenal food passage (esophagojejunostomy with a Roux-en-Y configuration) and a restitution of the intestinal continuity with a preservation of the duodenal passage (esophagojejunostomy with Roux-en-Y configuration and forming of the lateral-terminal jejunoduodenal anastomosis double tract and jejunal interposition by Longmire). The surgeries in these categories can be combined with forming of an enteral pouch or a stomach reservoir which would simulate a reservoir of a normal intact stomach. The ideal reconstruction procedure after total gastrectomy should replace all lost functions of the stomach. Preservation of duodenal transit with replacement of the jejunal segment, the so-called physiological route, is now believed to be preferential for postoperative nutritional condition, prevents persistent postgastrectomy syndrome, and improves the quality of life. Reconstructive procedures which allow duodenal passage should be regarded as a key to physiological reconstruction.

**Keywords:** gastric cancer, total gastrectomy, reconstructive procedures, nutritive status, quality of life

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
