Nutritional state, growth rate, and morphology after total gastrectomy with restoration of duodenal passage or Roux‐en‐Y oesophagojejunostomy with or without a pouch: an experimental study in pigs

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. Copyright © 1998 Taylor and Francis Ltd.