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Restoration of function after total removal of stomach for Cancer ….. Jejunal Pouch

Cancer of stomach is a life-threatening disease. Often part or whole of the stomach is removed as a part of its surgical treatment. Since stomach is an important organ for digestion, patients may suffer severe nutritional deficiencies after its removal.

Jejunal pouch reconstruction is “unique” for long term outcome

Case

53 years lady from Haryana presented with black stools, her endoscopy showed multiple polyps in the stomach. Biopsy from the polyps suggested low grade cancer. After evaluation she underwent removal of the stomach since the tumor was extensively occupying the entire stomach (Pic1). Once the stomach was removed, we need to restore intestinal continuity using small bowel. However, doing so patient could have suffered nutritional setbacks with decreased appetite affecting oral intake of food and subsequent malnutrition.

Considering the patient being young and expected long life expectancy after surgery, we intended to improvise our technique of restoring intestinal continuity which would possibly provide her with better nutrition outcomes. Hence a pouch was created using small intestines and joined it to the esophagus (pic2a/b/3). Patient recovered well after surgery and at 2 yrs follow-up her weight is stable and she can have near normal meals.

Stomach, apart from being a digestive organ, works as a reservoir when we eat. Digestive capacity cannot be restored following its removal but if we create a pouch of small bowel to restore the continuity it might replicate the reservoir function which in turn prevent early satiety leading to better eating pattern and with passage of time the reservoir will expand leading to near normal food intake which may restore the nutritional balance in her life.

We cannot negotiate with the cancer as often a vital organ bearing the tumor needs to be removed but we can at least improvise our techniques “Pouch after total Gastrectomy” to provide the patient a better quality of life after surgery”    

Categories: General, Stomach Cancer

Tags: Blog, Stomach Cancer