Ileocolon interposition as a substitute stomach after total or proximal gastrectomy.

Abstract

The authors evaluated ileocolon interposition as a substitute stomach after total gastrectomy (TG) or proximal gastrectomy (PG). Although the jejunum frequently is used for reconstruction to create a substitute stomach after TG or PG, there are few reports on ileocolon interposition. The authors performed ileocolon interposition in 47 patients who underwent TG (N = 18) or PG (N = 29) for malignant gastric lesion and evaluated the function of this structure as a substitute stomach using esophagoscopy, manometry, pH-metry, emptying time, oral glucose tolerance test (OGTT), and postoperative body weight changes. No patient reported any reflux symptoms or showed endoscopic findings of reflux esophagitis. These results were well supported by manometry and acid loading pH-metry. Emptying time and OGTT showed good capacity as a reservoir of food, and the postoperative body weight averaged more than 90% of preoperative weight. Clinically, no significant difference between these two groups was recognized during long-term follow-up for up to 12 years after operation. There were no cases of direct operative death, and the 5- and 10-year survival rates were 64.7% and 40.2%, respectively. Ileocolon interposition after TG or PG has the advantages of preventing postoperative reflux esophagitis and of providing functional replacement of the stomach as a reservoir for ingested food.