Objective: To compare the effect of restoration of duodenal continuity by a Roux-en-Y oesophagojejunostomy with or without a pouch on nutritional state, growth, and morphology after total gastrectomy in pigs.
Design: Experimental study.
Setting: Teaching hospital, Sweden.
Material: 60 Swedish domestic pigs.
Interventions: 54 pigs underwent total gastrectomy and 6 had sham operations. 20 pigs had reconstruction by a Roux-en-Y oesophagojejunostomy, 21 had a jejunal loop interposed between the oesophagus and the duodenum, as 13 had a oesophagojejunostomy with jejunal pouch on a Roux-en-Y loop.
Main outcome measures: Weight, laboratory indicators of nutritional state, and histological appearance of the gut.
Results: Growth was significantly retarded in those pigs that had had gastrectomies (p < 0.001) but there were no differences among the experimental groups. Haemoglobin, albumin, and calcium concentrations were significantly lower in the experimental groups than in the control group (p=0.006, 0.02, and 0.002, respectively). Histological examination showed subtotal villous atrophy in the experimental groups, most obvious in the pouch group. Colonic mucosal height was reduced in the experimental groups.
Conclusion: This study failed to show any advantage in growth rate when restoration of duodenal continuity or a small bowel pouch were compared with a conventional Roux-en-Y oesophagojejunostomy after total gastrectomy. However, restored duodenal passage seemed to benefit calcium homeostasis.