The сoncept of jejuno-gastroplasty as a physiological a way to restore the digestive tract

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Abstract

Jejuno-gastroplasty has its own history, directly related to the history of gastric surgery, being its continuation and variety. However, for almost 80 years, for a number of historical reasons and the dominant conservative approach it has not been properly developed in our country, due to the "technical complexity". The staff of A.V. Vishnevsky National Research Scientific Surgical Center has accumulated the experience of more than 350 operations using the jejunum segment on the vascular pedicle, during primary and reconstructive operations on the stomach. The accumulated experience of the Center allowed us to develop the principles of jejuno-gastroplasty as an alternative option for reconstructing the digestive tract after gastric resection and gastrectomy.

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About the authors

Valentin A. Kozlov

A.V. Vishnevsky National Medical Research Center of Surgery

Author for correspondence.
Email: kozipan@mail.ru

M.D., the chief of the upper digestive tract reconstructive surgery department

Russian Federation, Moscow

Dmitry V. Ruchkin

A.V. Vishnevsky National Medical Research Center of Surgery

Email: ruchkindmitry@gmail.ru

Ph.D., research fellow of the upper digestive tract reconstructive surgery department

Russian Federation, Moscow

References

  1. Osminin S.V., Komarov R.N., Ivanov D.L. Methods of reconstruction of the gastrointestinal tract after gastrectomy for gastric cancer. Experimental and clinical gastroenterology. 2020;(12):68-75. https://doi.org/10.31146/1682-8658-ecg-184-12-68-75
  2. Uvarov I.B. Asipovich 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). 58-78.
  3. Liu Y.H., Meng R., Zhu B., Zhang K.K., Yang H., Ding G.Y., Jia S.L., Xu V.G. Meta-analysis of the effectiveness of Ru-en-Wu anastomosis and jejunum interposition after total gastric resection. The World Conference. 2023, April 25;21(1):136. doi: 10.1186/s12957-023-03002- z. PMID: 37098553; PMCID: PMC10127366.
  4. Brekhov E.I., Mizin S.P., Repin I.G., Mkrtumyan A.M., Shipova A.A. Experience in using various methods of reconstruction of the digestive tract after extensive gastric resections and gastrectomies in terms of long-term functional results. Kremlin medicine -M. No. 3, 2011. pp. 125-128.
  5. Clark K.J., Thirlby R. K., Picozzi V. Jr., Schembre D.B., Cummings F.P., Lin E. Current problems in surgery: stomach cancer. Current problematic operation, August-September 2006; 43(8-9):566-670.
  6. A Popov.M., Dambaev G. Ts., Skidanenko V.V. et al. // Reconstruction of the digestive tract in advanced gastric cancer after gastrectomy with the formation of an artificial reservoir according to Hoffman // Asta LLC biomedika nauchno, 2017, Vol. 2, N6 p. 146-152.
  7. Kravchik V., Lorenz Z., Mietla M., Nich M., Svich M. The quality of life of patients depending on the method of reconstruction of the gastrointestinal tract after gastric resection for gastric cancer. Kazakhstan Tyrokean Republic until January 1, 2023;24(6):2177-2186. doi: 10.31557/APJCP.2023.24.6.2177. PMID: 37378950; PMCID: PMC10505866.
  8. Zakharov E.I. Zakharov A.E. Yunogastroplasty in diseases of the operated stomach. M.: Medicine. - 1970. – 232 p.
  9. Zherlov G.K., Koshel A.P., Nesterov V.V., Vorobyov V.M. Reconstructive gastroplasty in the treatment of operated stomach disease. Surgery No. 3, 2006. - pp. 15-21.
  10. Kupriyanov P.A. Plastic surgery of the pyloric part of the stomach using the small intestine. The New Surgical Archive. – 1924. – vol. 6. – No. 1. – pp. 49-54.
  11. Zakharov E.I. On the issue of gastric resection using a new technique. Protocols of the Pirogov Surgical Society in Leningrad on December 18, 1938. Bulletin of Surgery named after I.I. Grekov. 1939. –vol. 58. No. 1. p. 75.
  12. Busalov A.A., Komorovsky Yu.T. Pathological syndromes after gastric resection. M.: Medicine, 1966. – 240 p.
  13. Vilyavin G.D., Berdov G.D. Diseases of the operated stomach. M.: Medicine, 1975 p.- 296.
  14. Collis J.L. Surgery for a hernia of the esophageal orifice of the diaphragm with a short esophagus. The chest. September 1957; 12(3): 181-8. PMID: 13467876; PMCID: PMC1019207.
  15. Coincidel I.V., Ishchenko R.V., Sedakov I.E., Coincidel O.V., Balaban V.V. The use of Collis gastroplasty in the surgical treatment of hernias of the esophageal orifice of the diaphragm. Surgery. The magazine named after N.I. Pirogov. 2021;(6):30 37. https://doi.org/10.17116/hirurgia202106130
  16. Ganichkin A.M. Reznik S.D. Methods of restoring gastrointestinal continuity during gastric resection. Leningrad. Medicine. 1973. 178 p.
  17. Polyakov M.A. The immediate and long-term outcomes of her gastroplastic operations in gastric cancer. Dis. ...doctor of Medical Sciences. – M.: 1988 372 p.
  18. Nissen R. Erhaltung des Antrums statt totaler Gastrektomie bei der Operation des hochsitzenden Magenkarzinoms. Schweiz. Med. Wchnschr. 1954. Vol. 84. №16. P. 439-440.
  19. Oleksienko V.V., Efetov S.V., Zakharov V.A., Aliyev K.A., Al-Nsour D.M. Funktsional' NYE rezul'taty rekonstruktsii pishchevaritel'nogo trakta posle gastréktomii (s kommentariem) [Functional results of digestive tract reconstruction after gastrectomy]. Khirurgiia (Mosk). 2017;(1):36-41. Russian. doi: 10.17116/hirurgia2017136-41. PMID: 28209952.
  20. Otsuka R., Hayashi H., Hanari N., Gunji H., Hayano K., Kano M., Matsubara H. Laparoscopic double-tract reconstruction after total gastrectomy for postoperative duodenal surveil-lance: Case series. Ann Med Surg (Lond). 2017 Aug 1;21:105-108. doi: 10.1016/j.amsu.2017.07.080. PMID: 28808566; PMCID: PMC5544470.
  21. Aikou T., Natsugoe S., Shimazu H., Nishi M. Antrum preserving double tract method for reconstruction following proximal gastrectomy. Jpn J Surg. 1988 Jan;18(1):114-5. doi: 10.1007/BF02470857. PMID: 3386066.
  22. Hao X.S., Li Q., Yin J. The application of FJI and its comparison with different ali-mentary reconstructions after total gastrectomy for cancer. Chinese-German J Clin Oncol. 2022;1:79–81. doi: 10.1007/BF02851702.
  23. Hangtian C., Huabing H., Tianhang L., Xiaoyi Y., Guoen F. Isoperistaltic versus antiperistaltic uncut Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a propensity score matched analysis. BMC Surg. 2020 Nov 7;20(1):274. doi: 10.1186/s12893-020-00936-z. PMID: 33160348; PMCID: PMC7648979.
  24. Betaneli A.M. Heronogastroplasty in gastrectomy and gastric resections. Betaneli A.M., Yashvili A.A. Simferopol 1962. pp. 155-158.
  25. Kirikutse I., Urbanovich V. The use of the duodenum to restore the continuity of the digestive tract after gastrectomy. Surgery. 1959. No.8. pp. 43-48.
  26. Karnbaum S., Schnur A. "Jejunum-Magen" nach Totalresektionn des Magens. Chirurg. 1959. No.5. pp. 231-233.
  27. Borisov V.G. Gastric resection and gastrectomy with duodenal inversion. Symposium on her gastroplasty in gastrectomy and gastric resection. Sim-feropol. 1962. pp. 159-166.
  28. Karavanov G.G., Filts O.V. Clinic, diagnosis and treatment of some post-gastrosection syndromes. Symposium on her gastroplasty in gastrectomy and gastric resection. Simferopol, 1962. pp. 63-70.
  29. Komorovsky Yu.T. On the classification of modern methods of creating an artificial stomach. The works of Ternopil Med. Institute. Vol. 1. Ternopil. 1960. pp. 43-52.
  30. Popov V.I., Pomosov D.V. Replacement of the stomach with the colon after gastrectomy and subtotal resection. Symposium on her gastroplasty in gastrectomy and gastric resection. Simferopol, 1962. pp. 171-176.
  31. Ageenko V.A. Comparative study of a certain Pythagorean apparatus after liver resection with e-nonogastroplasty and Bilrot II. Dissertation of the Candidate of Medical Sciences. Irkutsk, 1966. p. 156.
  32. Ambartsumyan G.A. The choice of reconstruction of the digestive tract after gastrectomy (literature review). Bulletin of Surgery of Armenia named after G.S. Tamazyan. 2010; 2: 31–43.
  33. Makarenko T.P. Some types of operations include the duodenum in digestion after gastrectomy and gastric resection. Symposium on her gastroplasty in gastrectomy and gastric resection. Simferopol, 1962. pp. 177-180.
  34. Sweat E.J. Dumping syndrome and its surgical treatment / E.J. Sweat // American surgeon. 1957. Vol. 23. No. 12. p. 1097.
  35. Rotkov I.L. Isoperistaltic and antiperistaltic small intestine surgery during gastric resection. Symposium on her gastroplasty in gastrectomy and gastric resection. Simferopol. 1962. pp. 191-196.
  36. Meiman Z.A. Surgery. 1964. No.9, pp. 13-15.
  37. Kushieri A. Reconstruction of the jejunum after total gastric resection for cancer: experience in 29 patients. British Journal of Surgery. Volume 77. Issue 4. April 1990. pp. 421-424.
  38. Merendino K. A., Dillard D. H. The concept of replacement of the sphincter with a displaced segment of the jejunum in anatomical and physiological anomalies in the esophageal-gastric junction. Ann Serg, 1955; 142:486-509.
  39. Yudaev Yu.I. The replacement of the stomach by the small intestine during its resection. Surgery. 1959. N 12. pp. 70-73.
  40. Zherlov G.K., Koshel A.P. Primary and reconstructive immunogastropalasty in surgery of gastric diseases. Tomsk. 1999. 212 p.
  41. Patent No.2712042 Russian Federation, MPKA61B17/00(2006.01), A61B17/11 (2019.08). Method of forming an antireflux valve on an interpolated segment of the jejunum after gastrectomy: No.2019109125: application 28.03.2019: publ. 24.01.2020/ Ruchkin D.V., Kozlov V.A. – 12 p.: ill.
  42. Boerema J. A new technique of total gastric resection. Act of cheer. Belg., 1954. No.53. pp. 507-517.
  43. Henry K.K. Gastroplasty after complete gastric resection. Act. Cheer. Belgium. 1957. Vol.56. No. 9. pp. 956-962.
  44. House R.P. Anatomical and physiological reconstruction after total gastric resection using a jejunum food pouch // Surgical Forum. – 1953. – vol.4. – 231-236.
  45. Popoff G. Ersatzmagen ais dem Dunndarm nach totaler Gastrectomie. Zbl. Chir. 1956. V. 81 (33a) P. 1467-1470.
  46. Zakharov E.I., Zakharov A.E. Small intestine plastic surgery in gastrectomy and gastric resection. M. State Publishing House of Medical Literature. 1962. From 167.
  47. Patent No.2712064 Russian Federation, MPKA61B17/00(2006.01), A61B17/11 (2019.08). Method of its gastroplasty with the formation of a symmetrical isoperistaltic reservoir: No.2019109122: application 28.03.2019: publ. 24.01.2020/ Ruchkin D.V., Kozlov V.A. – 11 p.: ill.
  48. Androsov P.I. The experience of replacing the stomach with the colon after gastrectomy and subtotal resection. Symposium on her gastroplasty in gastrectomy and gastric resection. Simferopol, 1962. pp. 171-176.
  49. Lee C.M. Transposition of a colon segment as a gastric reservoir after total gastrectomy. Surg. Gynec. Obst., 1951. 92. №4. 456-466.
  50. Matyashin I.M. Plastic surgery of the esophagus by the colon: Dis.... Doctor of Medical Sciences. Key-ev. Health. 1964. 192 p.
  51. Moroney J. Colonik replacement of stomach. Lancet. 1951. V.18. N 1. P. 993-999.
  52. D`Errigo Retablissement de la continuite du tube digestiv après G.E.T. au colon transverse. Giorn. Ital. Chir. 1950. №6. 262.
  53. McCorkle H.J., Harper H.A. Ann. Surg., 1954. 140. №4. P. 467-474.
  54. Ann. Surg., 1954. 140. №4. P. 467-474. doi: 10.1097/00000658-195410000-00003
  55. Ganichkin A.M. Reznik S.D. Methods of restoring gastrointestinal continuity during gastric resection. Leningrad. Medicine. 1973. 178 p.
  56. Manteuffel-Szoege L, Sitkowski W. jr. plastyka górnej cześci zoładka za pomoca cześci jelita grubego [plastic surgery of the upper part of the stomach with a portion of the large in-testine]. pol tyg lek (wars). 1955 dec 19;10(51):1653-5. polish. PMID: 13310309.
  57. Velikolug K.A. Modern approaches to the problems of medical and social rehabilitation of gastroenterological patients and the disabled: abstract: dis. ... doctor of Medical Sciences / K.A. Velikolug // - M.:– 2013. – 42 p.
  58. Baitmanov N.N. Reparative processes in the walls of the stomach in an experiment. Experimental surgery. 1974. No. 6. pp. 33-35.
  59. Feofilov G.L., Pascal A.A., Mozartov V.D. Gastric reimplantation. Technical, functional and morphological results. Experimental surgery. 1975. No. 2. pp. 21-24.
  60. Markova G.F. Clinic and treatment of the consequences of complete gastric removal. M. Med. 1969. p. 160.
  61. Ugolev A.M. Membrane digestion. L. Med. 1972. P.146.
  62. Popov V.A. Membrane digestion in surgical pathology. M. Med. 1982. p. 191.
  63. Metelsky S.T. Physiological mechanisms of absorption into the intestine. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2009. No. 3. pp. 51-56.
  64. Danielyan G.A. Replacement of a stomach defect after its resection with a section of the rectum. Questions of radiology and oncology. Vol. 4-5. 1960. pp. 413-425.
  65. Pomosov D.V. On the issue of replacement of the resected stomach with a segment of the colon. Surgery. 1962. No. 2. pp. 53-58.
  66. Komorovsky Yu.T. Reconstructive gastrojunoduodenoplasty in pathological syndromes after gastric resection // Bulletin of Surgery 1962. Vol. 36. No.3. pp. 32-43.
  67. Vilyavin G.D. The functional significance of eunoplasty in gastrectomy and gastric resection / G.D. Vilyavin, B.A. Berdov // M.: Medicine, 1968. - 224 p.
  68. Pavlov I.P. Physiological surgery of the digestive canal. Complete collection of works, 2. Ed. 2.e. M.-L., 1951, 2, p. 285.
  69. Vitebsk Ya.D. Pathogenesis, prevention and surgical treatment of postresection syndromes. Chelyabinsk. South. Ural. publishing house, 1984. 152 p.
  70. Kodera Y, Yamamura Y, Kanemitsu Y, Shimizu Y, Hirai T, Yasui K, Morimoto T, Kato T. Use of a segment of transverse colon as a gastric substitute after total gastrectomy: an audit of 18 patients. Gastric Cancer. 2001; 4(2): 60-5. doi: 10.1007/pl00011725. PMID: 11706762.
  71. Boyko V.V., Lazirsky V.A. The use of the ileocecal segment of the intestine at the reconstructive stage after combined gastrectomy. Innovations in science. 2013. No. 25. pp. 157-171.

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2. Fig. 1. Variants of the distal jejunogastroplasty (JGP): a - isoperistaltic distal JGP; b - antiperistaltic distal JGP; c – distal JGP with isoperistaltic pouch; d- distal JGP with isoantipistaltic pouch.

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3. Fig. 2. Variants of the proximal JGP: a - proximal isoperistaltic JGP (according to Merendino-Dillard); b – proximal peripheral JGP (according to Yudaev).

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4. Fig. 3. Variants of JGP after GE: a – isoperistaltic; b - antiperistaltic; c – iso-antiperistaltic; d - with antireflux valve.

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5. Fig. 4. Variants of reservoir JGP: a – JGP with a symmetrical pouch; b – JGP with a symmetrical triple pouch; c – JGP with a proximal pouch; g – JGP with a distal pouch; d – JGP with a symmetrical isoantiperistaltic pouch; e – JGP with a symmetrical isoperistaltic pouch.

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6. Fig. 5. Types of CGP after GE: a – isoperistaltic CGP (transverse colon); b – antiperistaltic CGP (transverse colon); c – CGP with a part of the ileum.

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7. Fig. 6. Subtotal cologastroplasty: а – antiperistaltic distal CGP; b – isoperistaltic distal CGP; c – isoperistaltic proximal CGP.

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