Document Detail

Pouch vs. no pouch following total gastrectomy: meta-analysis and systematic review.
MedLine Citation:
PMID:  19672251     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Whether reconstruction after total gastrectomy for gastric malignancies should be done with or without a pouch is a controversial issue in clinical research. There is still no consensus on the reconstruction technique of choice. The aim of this report was to assess the value of pouch formation as a gastric substitute after total gastrectomy compared with reconstruction techniques without a pouch. METHODS: A systematic literature search of the Medline database and the Cochrane Library was carried out and a meta-analysis executed according to the Quality of Reporting Meta-Analyses (QUOROM) statement. Only randomized controlled trials (RCTs) comparing reconstruction techniques with and without a pouch were eligible for inclusion. All trials were independently assessed by two authors. Data on perioperative parameters, postgastrectomy symptoms, eating capability, body weight, and quality of life were extracted from the RCTs for meta-analysis using random-effects models for the calculation of pooled estimates of treatment effects. RESULTS: Nine RCTs comparing Roux-en-Y reconstructions with and without pouch and four RCTs comparing jejunal interpositions with and without a pouch were included. The results of the meta-analyses show that additional pouch formation does not significantly increase morbidity or mortality and does not considerably extend the operating time or the hospital stay. Patients with a pouch complained significantly less of dumping and heartburn and showed a significantly better food intake postoperatively. Quality of life was significantly improved in patients with a pouch compared with patients without a pouch. This difference even increased over time from 6 to 12 and 24 months postoperatively. CONCLUSIONS: This meta-analysis highlights some clinical advantages of pouch reconstruction after total gastrectomy.
Ralf Gertler; Robert Rosenberg; Marcus Feith; Tibor Schuster; Helmut Friess
Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2009-08-11
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  104     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-05     Completed Date:  2009-12-01     Revised Date:  2010-05-06    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2838-51     Citation Subset:  IM    
Department of Surgery, Klinikum rechts der Isar, Technische Universit?t M?nchen, Munich, Germany.
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MeSH Terms
Anastomosis, Roux-en-Y / methods*
Follow-Up Studies
Gastrectomy / methods*,  mortality
Jejunum / surgery*
Neoplasm Recurrence, Local / mortality,  pathology*
Postoperative Complications / physiopathology
Randomized Controlled Trials as Topic
Reconstructive Surgical Procedures / adverse effects,  methods*
Risk Assessment
Stomach Neoplasms / mortality,  surgery*
Surgically-Created Structures / utilization*
Survival Analysis
Treatment Outcome
Comment In:
Am J Gastroenterol. 2010 May;105(5):1208; author reply 1208-9   [PMID:  20445520 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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